P - 817401-374-(�,71 REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of�lectricity
- 1-374^�71 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
F%hert C;lauson (651) 642-0800 TTY/MRS 1-800-627-3529 � w
�6511 777-7$$5 �'K'H'•electricity.state.mn.u�NSPECTED LOCALLY
Identify the work covered by this requesY.
�IEW ��EMODEL �IADDITION I� REPAIR � ��
SUPPLIES
401 to
Above
Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A aratus �$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI�
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL FEES
Li htin Retrofit �$25 per Fixture
Center Pivot irri ation Boom �$40
Manufactured Home Park Lots � $25
Recreational Vehicle Park SRes � $5
Se rate Bondin Ins 'on � $2
Sp9Cial InSp2Cf10� � $30 Def HOUf
Su lemental Fee � $20
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformers / Power Su 1 for Si ns / Outline Li htln �$:
ONE & TWO FAMILY DWELLINGS, EACH UNIT
includes the Service and/or Power Supp�y up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$80
Additional Insoection Trios � $20
FOR INSPECTOR USE INJLY
�:V ��,�,� �'�-6 �rd
��� —
I hereby cerlity Ihat I inspected ihe eleciricel installation des
ROUGM IN
FIIJ�L INSPECTION '
OTAL FEE
fee is $201
herein on the tletes steted:
DATE
f DATE
'� f--�d'�%
FOR OFFICE USE ONLY
I IIIII) IIIII IIIII IIIII��I) IIIII II� �IIIII ��# �ay y �
* 1 374071 7"' �uri��
6258-2001
Aequest Date: Rough-in Inspection Required? �Yes ❑ No Inspection Other Than Rough-in: ❑ Ready Now �1Nill Call
3/14/01 You must call the inspector when ready! Date Ready:
I cer�ify that I am the �.ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the elechical work at:
Job Address (Street, Box, or Route No.) Ciry Zip Code
7415 University Ave Fridle
Section Township Range Fire No. County
Anoka
Occupant Phone
Sunridge Homes (651}653-4032
Power Supplier � Address
EXCeI Energy (NSP) ' 3115 Cerdre Pointe �ive, Rosevdle, MN 55113 -(831 �28-2000
Electrical Contractor / Company Name Contractor License Number Master License Number
Aircon Electnc Corporation CA00141
Mailing Address (Contractor, Company or Owner Performing Installation)
2343 5th Lane Nw -- Andover MN 55304
Aut zed Sign ture (COntrector, ny or Owner P ' g Installation) Phone
(763) 757-2120
EB 7/1/2000 BOARD OF ELECTRICITY COPY INSTRUCTfONS ON BACK OF YELLOW COPY