P - 81736i-374�770 REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
1-374-070 g 1821 University Avenue Su�te S-128, Saint Paul, Minnesota 55104
&;obert C;►auson (651) 642•0800 TTY/MRS 1-800-627-3529 �
(6511777-7$ii5 www.electricity.state.mn.0 �NSPECTED LC7CALLY
Identify the work covered by this request:
EW EMODEL DDITION REPAIR �
GENERAL FEES Oi�oor Li finq Standard �$1
Above 800
IRCUITS i FEI
0 to 200 Ai
Above 200
ALARM,COMM
CIRCUITS. CIR�
�
� $5
e � $10
TION, REMOTE' C
OF LESS THAN 50
to 10 KVA �
�;
a. ° -
� j���':
`,:,. ...:.......:.: �;...:..:' '
ONE & TWO FAMILY DWEILINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$t
Additional Insoection Trios � $20
(minimum total fee is �20) � yJo�
FOp INSPECTOH USE ONLY
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I hereby certify Mat I inspecled the eledrical ins[allation describeE �erein on Me dates sfeted:
ROUGH IN OATE
FINAL INSPECTION DATE
� ►� f � /o'_O L
FOFi OFFiCE USE OMLY
IN�IIIiII{{I�I � �� �G/ i
! ill III 111�1 II I{i INII IIIII III{I II
* 1 3740709' �'S�
Request Date:1 Rough-in Inspection Required? �Yes ❑ No Inspection Other Than Rough-in: ❑ Ready Now �Will Call
3114lQ1 You must call the inspector when ready! Date Ready:
I certify that I am the [�ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address (Street, Box, or Route NoJ Ciry Zip Code
Section Township Range Fire No. Counry
Anoka
Occupant �hO�
Sunridge Homes � (651)653-4032
Power supplier tld�i ss
Excel Ener NSP 3195 CenMe Pomte Drive, Roseviqe, MN 55113 -(651�28-2000
Electrical Contractor / Company Name Contrector License Number Master License Number
Aircon Electric Corporation CA00141
Maiiing Address (Contractor, Company or Owner Performing Installation)
2343135th Lane Nw -- Andover MN 55 phone
e��rti„��ar� � nar��r (Contractor, Com any or Ow Installation)
' (763) 757-2120
����200p BOARD OF ELECTRICITY COPY INSTRUCTIONS ON BACK OF YELLOW COPI