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P - 76951
From: C�y of Fri�ey To: 78371794�8 Minnesota Deparhr�ent d Labor �d indus�r � ���� � St Paul, MN 55-4342 Phone: (651 84-a064 TIY/MRS: 1) 297-4198 vwwv_ .seata.mn.us Contractor R uest fior Eiectrical �('� Rough-In Inspedion Requmed? "1 "� 'l/� Conhac�or Must Sdiedule AU tZou Avares� vr aispa�,ru� — auvei �e.�ao �3�� s� nlaur�e �e�.� P�Iat�C Owner Telephc vl�Z Contracroor Nar r Contr�or TeM I�.�z��� a ��w�a��a�—aaai ���-Gar�� : �e ����r� � c �hone Number � Ns�r Hon� or As:oci�ad �� Yes Riige: ?l1 OsAe: 91T/Z0071215:51 PM � � 4� - �lV �� I�C'D S E P 10 2007 — 0116 Must Schedule Ap Structure R�dY No�► � 1MN Sc��edute �rld1-� � Gw�vKa. ��� i ns���f ���e. w iu� a,�� �.u��� p��l TYI��'IZ0.� Ylk w� �j��i(�.`�`> rY�GCe-� C C�X1� CU'l�li,�-Lk S S�VV1Ce Ct��1�1,,ieiU'S�'Urnu'Y�Q'�.C'Y`C� �� � C1�ZR1nc� Sevvl�e�-�,Cc��e - �i1c�✓Lj�'l��.ir�c� � Yv\e,t'. �-it.v�C:� ' +� �� O2/� ,� l.�j �a,C� l��/c� S�y�� s� Ebctric;al Ub'I�y �►�� �/���.� �u�l I i�c� Fee Catculation New o�� se� s„�yo -4o a�� s3s NeMr Dw�e�irg Se�vioalPo�wer Supply 401— 800 ampere � S60 New Dweig FoederslCircuits New Hane — �n 30 F�d�Ci� - To 200 A@ SB Esch D�ad�ed Garags or Oth� Assacie�ed StrucWre New ServioelP�ow�er Supply 0— 400 ampere � S35 N�v Feeders/Circ�i� i i��B Each ! cJ�- CQi z - Existlnp HomalStrudu�e Romodal or A�ddi�ion Naw ServioeJPower Su�i�r New servicelPower s�,ppir u �400 ampe�e � t35 401— 800 ampere � �80 — Up to 15 Feodsrs�'C'rais t � Feedara�ci�,is � i2 F�ch I Dsbsd�sd Gsraee or Otl� Associalsd Sbudurs New Servioe/Power Supphr 0—�00 ampere � i� Ne�6dended F� i )� SB Each R�orm�d FeedersliC'sr:uNs ( ) � i2 F.ach �- Olher (SPeciY) Other (Spec�fl� . �J 1.r��r,�t vl/ Total {the fes c�tad above ar i35 muiHpNed Total {the tes c�la,lated above or i35 muWp�ll�ed � �(� by the roun6er of ►ec�,:ed ir�spe�tior► t�pa. �--�� by,he rwmber of r.qurea ir�pedion ai�s, .- '� > � c� ,,� whic��sver is groaber) - '-���='_���:. - �ever is ge�) '� �-'" ;"".-a'�': q�qu� tor EMcNaI Y�tlon if� wMh siM af i� ar Nss �aq�b 12 �naMhs � 11r fliin� A�. T!r oon�or �eu�t haN 1!M wak oan�plM�d�rllhin the 1Z �nonlh P�riod w sJ�it ano�► Rdtlat IneMKM� 11�e Itrp�dlon iM torrie Ynea�I�Md w�Ork. Mrp�fion iNS do not Ca�► awr►i�on� on� RB b � A s�rMc� ehr� d i� wftl b� a1YNd fn► aN dslwnond elwdcs. 1 harebv Ceriiv lhal 1 insoec�d t�e elscbieai iistaMiDn herein an fie ddea staled: DePrin�a Use 01t1y Rou� — in �nspectbn(s) This t�l ean bl TDD {651) �7-41�i. � 02 csion [�"7' Da�e �� � � � %�as. sreh as Ir�e ai�t B�i11e a on a ar