P - 817001-37�?61
.-� 1-374-061
Robert �iauson
t6511 777-7$85
Identify the work covered by this reques�
�JEW �EMODEL ICLI4DDITIO�
401 to 800 Ampere �
Above 800 Ampere �
-.
REQUEST FOR ELECTRICAL INSPECTION
❑Minnesota Board of Electricity
$ 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 17Y/MRS 1-800-627-3529
www.electricity.state.mn.u�NSPECTED LOCALLY �
� REPAIR
� Above 200 Ampere � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGI
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus �$.50
ADDITIONS TO THE GENERAL FEES
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
� $.31 oer Mile
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
� 7ransformers / Power Supply Tor Signs / Outline Lighting �$5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two inspection Trips Each Dwelling Unit �$80
Additional Inspection Trips � $20
Investi ative Fee
Reinspection Fee � $20
TOTAL FEE
(minimum total fee is $20)
FOR 1NSPECTOR USE IXJLY
�OUGH IN
FIN�L INSPECTION
herein On thB dHtes sfeied:
DATE
� ,2- �li'-a (
oare
� �i�dl'1.�%
FOR OFFICE USE ONLY
� �3 S
IIIIIIIIII(IlfllllllfllfllllllllllllM�(nI�I�I d
* 1 3 7 4 0 6 1 8'` ��
625d-20b1
Request Date: Rough-in Inspection Required? Yes ❑ No Inspection Other Than Rough-in: ❑ Ready Now ill Call
2/13l01 You must call the inspector when readyl Date Ready:
I certity that I am the �ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address (Street, Box, or Route No.) Ciry Zip Code
7411 University Ave Fridley
Section Township Range Fire No. County
Anoka
�unndge Homes Phone�651)653-4032
Power Supplier Address
NSP 3115 Cerdre Pante Drive, Rosev�le, MN 55113 -(631�28-2000
Electrical Contractor / Company Name Contractor License Number Master License Number
Aircon Electric Corporation CA(�141
Mailing Address (Contractor, Company or Owner PeHorming Installation)
234313�th Lai�e Nw -- Andover, MN 5530d
Authorized Sign tractor, Comp wner Perf ing Installation) Phone
(763) 757-2120
EB-00001A-13 1/2000 BOARD OF ELECTRICITY COPY INSTRUCTIONS ON BACK OF YELLOW COPY