P - 817381-374-f�73 REQUEST FOR ELEC7RlvAL INSPECTION
Minnesota Board of Electricity
' 1-374-073 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
t�`obert C:iauson (651) 642-0800 TfY/MRS 1-800-627-3529 `
(651 i 777-7$$5 www•electricity.state.mn.u�NSPECTED LOCALLY
Identity the work covered by this request:
I�JEW �EMODE� �DDITION � REPAIR , .
to 400 Ai
)1 to 800
0 to 200
�
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or Ap aratus �$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS (PER UNIT)
3 to 12 Units �$50 Per Unit
� $.31 per Mile
VUIW�
Traffic
to 10 KV/
�r 10 KVA
. �� ...
�� �
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Irxludes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Owelling Unit �$SO
Additional Inspection Trips � $20
Investi ative Fee
Reinspection Fee � $20
TOTAL FEE
(minimum total fee is $20)
FOF INSPECTOR USE ONLV ��
�.�..<..C.% G��.t �a � � � � � /C .
I hereby c
flOUC�HIN
FlNAL INSPECTION
installation descrfbed herein
OATE
DATE
., FOR OFFICE USE ONLY �
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"1 3740733* ��%��
B2B0-2001
Request Date: Rough-in Inspection Required? �Yes ❑ No Inspection Other Than Rough-in: ❑ Ready Now �Will Call
� 3�� 4i�� You must call the inspector when ready! 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 Raute No.) City Zip Code
7419 Universi Ave Fridle
Section Township Range Fire No. County
Occupant g � � � � � Phone �
Sunrid e Hom (651 653-4032
Power Supplier Address
Excel Energy (NSP) 3115 Centre Pomte Drive, RoseviNe, MN 55113 -{851�28-2�0
Electrical Contractor / Company Name Contractor License Number Master License Number
Aircon Electric Corpo�ation CA00141
Mailing Address (Contractor, Company or Owner Performing Installation)
2343135th Lane Nw -- Andover MN 55304
Authorized ' re tractor, Comp r O ner Perfo ' a on) Phone
(763) 757-212Q
EB-00001 - /1/2000 BOARD OF ELECTRICITY COPY INSTRUCTIONS ON BACK OF YELLOW COPY