P - 76646REQUEST FOR ELECTRICAL INSPECTION �'�
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� � ❑ Minnesota Boar�l of Eleekicity s� S„
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
, (651)642-0800TTY/MRS 1-800-627-3529 www.electricity.state.mn.us ��.;���
Describe -using the ack of the white copy if necessary - the work covered by thi request:
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GENERAL FEES Outdoor Liohtina Standard (� S1
I SERVICES I
Above 200 Am ere a$10
ALARM, COMMUNICATION, REMOTE CONTROI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aooaratus (� 8.50
3 to 12 Units @$50 Per Unit
Each AddiGonal Unit @ $25
OTHER ADDITIONAL FEES
Lighting Retrofit @ $.25 per Fixture
Center Pivot Irriaation Boom CaD $40
Traffic Signal Standard
Supplemental Fee @ $
Transformers up to 10 I
Transformers over 10 N
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dweliing Unit Q$80
Additional Inspection Trips @ $20
Investigative Fee
Reinscection Fee Ccil $20
total fee is
I herebv certitv that I inscected the
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installation described herein on the dates stated:
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DAIE
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� � Special Inspection @$.31 per Mile � �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12
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18204479
Date: Rou h-in Ins ection R uired?
g p eq ❑ Yes ❑ No Inspection Other Than Rough-In: ❑ Ready Now � Will Call
You must call the inspector when ready! Date Ready:
1 certify that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical wo�C at
Job Site Street Address ��y
�17 �-% S � �/% l�,e.d �—,�- y
Township w Section Range Fire No. Counry
Electripl
, Company or Owner
Niease Nrov�tle I wo (2) Phone Numbers Including Area Code
(�6� i����yZ (7�3�5'7r �g�e
Master Electrician or Power
License Number
Please Provide Two (2) Phone Numbers
\ � \ /
ELECTRICAL INSPECTIONS � � ' �`� PERMIT NO. �� � � ` � �'
CORRECTION ORDER , DATE !/ �� r
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Installer of Wiring (�� ' F i, c^ �
OwnedOccupant 1. � '"� j`' -? � ' Job '�c.;,P..�, �: �
Properry Address � ��f � '�i' �- �' � Zip
The following items are deviations from the accepted standards of construction at the above described
Correct the noted deficiencies and:
O Notify inspector for reinspection before covering wiring.
-�' Re-inspection will be made at tlme of next inspection.
�'CJ � Sign and return this form to Inspector when corrections have been made but no later
than (Da�:)
Signature of Installer
Robert Clauson
1586 E. Sextant Ave. Date of Compliance� �`/ ��,.
Maplewood, MN 55109 � �
Call 651-777-7885 for Reinspection - 7:00 - 8:30 a.m.
Monday - Friday except holidays.
RC-01