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P - 76357REQUEST FOR ELECTRICAL INSPECTION �— 8��� �� � Minnesota Board of Electricity J; 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 (651) 842-0800 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us Descri� -using the back of the white copy'rf Pecessary - the work covered by this reque.st: �►�i Z �� L � � �[ GENERAL FEES Outdoor '_ 'nq Standard a�. $1 I SERVICES / POWER ALARM, COMMUNICATION, REMOTE CONTROL CIRCUffS, CIRCUITS OF LESS THAN 50 VOLTS Each Svstem Device or Aaoaretus Ca) $.50 3 to 12 Units (d� $50 Per Unit Each Addi�onal Unit @ $25 orH�aoomoi Liuhtina Retrofit CrD. $.25 r�r F'octure Mlle ��������I��Ii���I����Id������0��� 182�2812 up to 10 KVF over 10 KVA ONE 8 TUVO FAMILY DWELLINGS, EACH UNIT Includes the Service andlor Power Supply up to 500 Amperes, AU Circuits and Two Inspection Trips Each Dwelling Unit @$80 Rein 'on Fee $20 TOTALFEE (minimum total fee is $20) ��=� �T1119AREAF�IINSPCCfORU5E0MY / (/ {�V► i ne�bY �, n� i mso�a me �ear� �e��anon a�t�re��t,e'daces sm�ea: � NOT COMPLETED WITHIN 12 MONTHS FUh OFFICE USE OFCt RECD MAY 2 4 2001 ��� ���� �� I �� Rough-in InspecUon Required? ❑Yes �No Inapectlon Other Than Rough-In: ❑ Ready fdow,$,Witl Cell �� y'�� You must ceU the inspector when readyl Date Ready: I certify that I am the � LICENSED CONTRACTOR ❑ COMPANY � OWNER and hereby request inspection of the elecfical work at Job Site Street Address � City + � N�'-� � �� t.�.� � I 1� ��' ToMmship Secdan Rar�ge Fl�e No. County A � a /� �� Oxmed Name � � Please Prov�e Taw (2) Pho�re Numbers Including Area CAde " �0 , ���,� ��� ��� �/—� f`�y( ) Elearical UtiUty Electricel Utillty Addrags � � � � �/Y �' �6..)' 7 mas�ar rreranc�n or License Number or or owner Perro instananon) Piease Nrowae rwo �z� Nnone rvumuera i � `r ` ('�)�'h%I .2�P�e/ ( ) � r�w Annan �F ci Frra�rm r�w