P - 77245REQUEST FOR ELECTRICAL INSPECTION
1— 7 4 O�� 7� � Minnesota Board of Elechiaty
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
❑ NEW 0 REIu�ODEL �ADDITION O REPAIR Describe -using the back M ihe white copy if necessary - Ne xrork covered by this request:
SERVICES I POWER SUPPLIES
0 to 400 Amoere �1 E25
ALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aooaralus � 8.50
S50 Per Unit
Unit � 525
�1
Transformers u to 10 KVA $10
Tr�sformers over 10 KVA @ E 20
� Transfomier I Power Supply for Sipns I Outline Lightinq _ 55
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Ir�cludes the Service aridlor Power Supply up to 500 Amperes, All
Circuits and Txro Inspection Trips Each Dwelling Unit @$60
AddiGonal Inspection Trips � $20
Investigative Fee
Reinscection Fee � $20
(minimum total fee is $20) � `f���o
TMSAItEAFd31N5PECTqiU5Ed1v ��
I hereby ceNfy tlwt I inspected the electrical install�on described f�rein on the dates sUrted:
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S �2� IfIS �Ofl f� f HOUf E�°ine�aarfn wTE �
S ial Ins tion $.31 r Mile
'HIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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rceques� /ua�ce: Rough-i� Inspeclion Required? LI Yes �No Inspedion Other Than Rough-In: ❑Ready No�y� V1r11 Call
y• J�. U� You must call the inspector when ready! Date Ready.
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I certiy that I am the �ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electricxl work at:
Job Site Address (SUeet �4 a Route No.) City Zip Code
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or
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�ower suppi�er ress Q �(� ,�
ic�$ �'/1 �-i �`�"`
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ANGEL ELECTRIC. INC. °
�92'7 �I,pRiCH AVE. N. BROOKLYH CEMER. MN'.PS�� —
(0�763�-�1�� w �63i•�Sp3�-7939
�pPl'TR.LIC.# CA03483 " MASTR.I3C # AAAO6S43 —
�pP(1'AGT-JIM C.(763}�b39"6737
EB-OOOOtM11 8.1. 2002