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P - 78496REQUEST FOR ELECTRICAL INSPECTION 1� J G�- 3 51 � Minnesota Board of Electricity - 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 (651) 642-0800 TTY/MRS 00-627-3529 www.electricity.state.mn.us ❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR Describe -using the b �l te copy if necessary - the work covered by this request: Furnace & A/C GENERAL FEES Outdoor Liahtina Standard l� $1 C'� � ,.� " 0 to 200 Ampere @ $5 Above 200 Ampere �$10 ALARM, COMMUNICATION, REMOTE CONTROL CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Each Svstem Device or Aouaratus � 8.50 to 12 Units @$50 Per Unit ach Additional Unit � $25 OTHER AD nhfina Rehofit� 5.25 cerf IIII IIIII IIIII IIIlI illll I�III IIIII IIIII �� I� 15263510 Includes ihe Service andlor Power Supply up to 500 Amperes, All Circuits and Two Inspection Trips Each Dwelling Unit �$80 TOTALFEE I (minimum total fee is $20) 2�. 51 TMS AREA FIX2INSPECTOR lbE ONLY I hereby cer6ry that I inspec0ed the elec6ical installa6on described herein on the dales slffied: �� � I ' COMPLETED WITHIN 12 MONTHS ��,� o� p..f d I Request Dffie: Roughin InspecGon Required? ❑ Yes � No Inspedion Other Than Rough-In: Ready Now O WNI Call 9/ 16 / 03 You must call the inspecla wh� reedy! oa�e rteaoy: I certiTy that I am ihe [�UCENSED CONTRACTOR ❑ COMPANY � OWNER and hereby request inspection of the eiectrical work at: �� s�ce naa.es5 �s�ree�. soX. a rw�,�e rio.� cny zP coae 7316 Symphonv Street NE Fridlev 55455432 iccupem name � /� Da.ryl Lediri �� Robbinsdale Electric lirw Address (Contrac[or. Comoanv a Owner F INSTRUC710N8 ON P,rioka Poease Provide Two (2) Phone Pkimber(s) I�duding Area Code � ) � ) �� Contractor Litxnse Number Master Electrieian or Wower Limited Tedmidan License Number CA01549 i) ale NIlV 55422 ,ea Phane �s) 763-588-7004 ELECTRICITV COPV E&OOOOtM14 8.1. 2002