P - 817391-37�i-074 R,�QUEST FOF�ELECT�iICAL INSPECTION
Minnesota Board of Electricity
1-374-074 '� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
Kobert Ciauson (651) 642-0800 TTY/MRS 1-500-627-3529
(651) 777-78$5 www.electricity.state.mn.u�NSPECTED LOCALLY
Identify the work covered by this request:
I�JEW �IEMODEL �DDITION W REPAIR }
GENERAL FEES .S '�. Outdoor Liahtina Standard �$1
to 400 Ampere � $;
)1 to 800 Ampere �
�
�ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aooaratus � 8.50
�ILY DWELLINGS (PER UNI�
2 Units � $50 Per Unit
Additional Unit � $25
OTHER ADDITIONAL FEES
np Retrofit � $25 per Fixture
�iOUf
Supplemental Fee � $20
Transformers up to 10 KVA �$10
� Transformers / Power Suppiy (or Signs / OuUine Lighting �
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes ihe Service and/or Power Supply up to 500 Amperes, Ail
Circuits and Two Inspection Trips Each Dwelling Unit �$F
Additional Inspectio� Trips � $20
Investioative Fee
: � � -.:
�:, - -
�.-: _
��s Y :
TOTAL FEE
(minimum total fee is $20)
iPECTOF USE ONLY ,(�-�
�-c v � � ,—a- 1' �-^ � !�� ''v
ROUGH IN
FINAL INSPECTION
da�ee :
DATE
/—�O—a
FOq OFFICE USE ONLY
IIIIIII III��IIII IIIII�IIII IIIII �IIIIIII�I ���" J ayy �
* 1 3740741 * ���SV �
s2s1-ZOOi
Request Date: Rough-in Inspection Required? �Yes ❑ No Inspection Other Than Rough-in: ❑ Ready Now �Will Cell
3l14101 You must call the inspector when readyl 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 No.) Ciry . Zip Code
7421 University Ave Fridley
Section Township Range Fire No. County
Anoka
Sunridge Homes Pn��e(651)653-403�
Power Supplier Address
Excel Energy (NSP) 31f5 Gerrtre Pointe Drive, RoseviHe, MN 55113 -(651�28-2000
Electrical Contractor / Company Name Contractor License Number Master L�ense Number
Air�on �lectric Corporation CA00141
Mailing Address (Contractor, Company or Owner Performing Installation)
2343 i Lane Nw -- Andover MN 55304
Authorize gnatur (Contractor, pan or Ow Installation) Phone
(763) 757-2120
E&00001A-1 7/1/2000 BOARD OF ELECTRICITY COPY INSTRUCTIONS ON BACK OF YELLOW COPY