Loading...
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: �- z3_�s � fHIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS IIII II lii II IN II II{ II III N III II III II iil II III I IIII 17813569 !t� �� 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: � Jo &i . �1re e _..- _ _ . _ _ __ _ - __. _ . _ . � City - $,��:� �"A`� �L1REh! ST NE FRIDLEY I Township I'--- --___ _. - _._ I �`��:�f""�AI�IDRF� �7 � ;�ecvica� utihty I Electrical Utility Address Please Provide Two (2) Phone Numbers I \ / \ / ! xc�� EhIEF:��r I _ _� 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 i � '� - -- — - _ — — — ! _ _ —__ -- -- � MaNing Address (Contractor, Company or Owner Performing Installation) ���ti0 TERF:ITORT�L. ROAD, SAIhlT F'AUL, �(hi 5511� ----� 9 _—� � __ �-----_. — A�� Si na�ntractor or Owner Performin Installation � I�ag�Proyicj��Twg,�7„1 ihpne � mbers Including Area Code I '-s [14 Y 1 j