P - 817371-374-072 REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
� 1-374-072 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
Rnbert Clauson (651) 642-0800 TfY/MRS 1-800-627-3529 .,
(651) 777-7$85 �'•electricity.state.mn.u�NSPECTED LOCALLY
tdentity ihe work covered by this request:
�IEW �EMODEL �14DDITION �REPAIR i
/POWER
/FEEDERS
ALARM, COMMUNICATION, REMOTE CONTFiOL,
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A paratus �$.50
ADDITIONS TO THE GENERAL !
MULTIFAMILY DWELLINGS PER UNIT)
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL FEES
Li htin Retrofit �$25 r Fixture
Center Pivot Irri ation Boom �$40
Manufactured Home Park Lots �
Recreatlonal Vehicle Park SNes �
Transfortners overl0 KVA � $20
Transformers / Power Supply for Signs I Outline Lighfing �$5
ONE & 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
Investigative Fee
Reinspection fee @ S20
TOTAL FEE
(minimum total fee is $20)
FOP INSPECTOR USE ONLV ��
� U+.4..�F ( �-� b F2'((�
I hereby certity that I inspected Me elec[rical installation desCribed herein on Me 08tea s�etetl:
ROUGHIN DATE
C�➢ $30 r Houf FiNn� iwsrecriori onre
� $.31 oer Mile � - -� � �D�' a
� FOR OFFICE USE ONLY
�•.�b i
I II� IIIII II�III IIIII IIIII II� IIII I�I
* 1 3740725* �'����
6259-2001
Request Date: Rough-in Inspection Required? es ❑ No Inspection Other Than Rough-in: ❑ Ready Now ill Call
3/14101 You must call the inspector when ready! Date Ready:
I certi(y that I am the �.ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address (Street, Box, or Route Na.) City Zip Code
7417 University Ave Fridley
Section Township Range Fire No. Caunty
Anoka
O upant. � Phone
�unridge Homes (651}653-4032
Power Supplier Address
Excel Energy (NSP) 3115 Cerrtre Pointe Drive, Roseviqee, MN 55113 -(851�28-20�
Electrical Contractor / Company Name Contractor License Number Master License Number
A�rcon Ei�ri� �Qr�ratiQn CA00141
Mailing Address (Contractor, Company or Owner Performing Installallon)
2343135th Lane Nw -- Andover, MN 55304
Authorized ' ure ( ntractor, Compa ner Perfortn In tlon) Phone
(763) 757-2120
EB-OOOOtA-1 7/1/2000 BOARD OF ELECTRICITY COPY INSTRUCTIONS ON BACK OF YELLOW COPY