P - 76280� �EQUEST FOR ELECTRICAL INSPECTION
1������J 2 4 � Minnesota Board of Electricity
- 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
' , (651) 642-0800 TTYlMRS 1-800-627-3529 www.electriciry.state.mn.us
Describe -using the back of the white copy'rf necessary - the work covered by this request:
E�CEL ENEFiG"f '�P��a'Efi `S SWTTCH
GENERAL FEES Outdoor Lighting Standard @$1
BERVICES I POWER SUPPLIES Traffic Signal Standard @$5
to 400 Am re $25 Supplemental Fee @$20
G01 to 800 Am re $50 Transfortners u to 10 KVA $10
Almve 800 Ampere (iil $75 Transformers over 10 KVA (�a � 20
Each
)M�IUNICATION, REMOTE CONTROI
CIRCUITS OF LESS THAN 50 VOLTS
ivstem Device or Aooaratus GD $.50
$50 Per Unit
Unit @ $25
OTHER ADDITI01
(a� $25 per Fixture
Includes the Seruice andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwrelling Unit @$80
Fee
total fee is $20) � �� ey�
I hereby certify that I inspected fhe electrical installation d�cribed herein on the dates stated: I
..__.�.._ ..... ........... . ............. .. ... y�.rr
te Bandi Ins 'on $20 -� � p -
S ial Iris ' n@$30 per Hour °�°�"�1N0°NED �^T�
"Special Inspection @ $.31 r Mile
(S INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
-------------------------; --------------------�----------RE�p J U N 14 2007 --------------
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�' - Rough-in Inspection Required7 ❑Yes �]NO Inspection OtherThan Rough-In: �Ready Now ❑Will Call
�f �. �. %� L�' 7 You must call the inspector when readyl Date Ready:
I i�rtify that I am 1he � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electricxl work at
JOb3iteStreetAddress ��FRIIILEY I'1ii °��4.:�s
59,:�� haE 5TN S1'
Tovrttship Section Ranae Fire No. CounN
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E[ectrical Utility Electripl Utility Address
�CEL EI�EF�G'�
COntrBCtOr / Company Name ConVactor License Number Master Electrician or P
HUhIT ELECTFiTC COF;F'QF+,A1'TOF�! Gf-i �?C�8$,'s ucenseNumber
IWeiling Address (Contractar, Company or Owner Perfarming Instellation)
�3C'�J. IERETTi7�:I�aL h17A�9 e�tTi�T F'r�IJLq f�ta 5511�
A rized Signafure (Contractor or Owner Performing Installation) Please Provide Two (2) Phone Numbers I
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Area Code