P - 773651 7 81 3 5 6 g REQUEST FOR ELECTRICAL INSPECTION °��
� � ❑ Minnesota Board of Electricity rr
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �: ,
. - (651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.stale.mn.us
pescnbe -using the back of the white copy if necessary - the work covered by this request: �
�xc�� �r����v saU��•s s���c►� �0� n�8%`�
0 to 400
401 to 8�
Above 8
UITS I f
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Home Park Lots i
'ehicle Park Sites
Outdoor Lighting Standard
Traffic Sianal Standard (�
Transformers u to 10 KVA $10
Transformers over 10 KVA @$ 20
Transformer I Power Supply for Signs / Outline Lighting @$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additional Inspection Trios (a� $20
TOTAL FEE I�� 5���
(minimum total fee is $20)
rnis nRea Foa wsaeeroa usE oN�v
that I inspecied the electrical installation descnbed herein on the dates stated:
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fHIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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17813569
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Rough-in Inspection Required? L] Yes �] No I Inspection Other Than Rough-In: [,�Ready Now 0 Will Call
You must call the inspector when ready! i Date Ready:
I certify that I am the p LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
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$,��:� �"A`� �L1REh! ST NE FRIDLEY
I Township
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;�ecvica� utihty I Electrical Utility Address
Please Provide Two (2) Phone Numbers I
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IC49{ �(oF� ��RaRY��P2C CGF��'al�Af �. ON �. Contractor l,i�gnse,�l}{rpbp{� Master Electrician or Power Limited Technician
1'lu�yt tl.� ttl l.fi i111�i�i� LicenseNumber
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� MaNing Address (Contractor, Company or Owner Performing Installation)
���ti0 TERF:ITORT�L. ROAD, SAIhlT F'AUL, �(hi 5511�
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A�� Si na�ntractor or Owner Performin Installation � I�ag�Proyicj��Twg,�7„1 ihpne � mbers Including Area Code
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