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P - 77633REQUEST FOR ELECTRI L INSPECTIO �� I 1� 8 2�° �F ( 8 �' Minnesota Board of Electricity ��, � �aSS,�p �': "° ❑ 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �' - (651)642-OSOOTTY/MRS1-800-627-3529 www.electricity.state.mn.us Describe -using the ack of the white copy if necessary - the work covered by this request: ^ l� � ��, SQ� v � csz /A-�i ✓ � � �r�P � �i,�:`�. �ICES I POWER SUPPLIES 0 to 400 Amcere C� $25 0 ro 200 Am ere $5 Above 200 Am ere $10 ALARM, COMMUNICATION, REMOTE CONTROL, SIGi CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Each S stem Device or Apparatus $.50 ADDITIONS TO THE GENERAL FEES MULTIFAMILY DWELLINGS PER UNIT 3 to 12 Units @$50 Per Unit Each Addflional Unfl (o? $25 Center Pivot Irrigation Boom � Manufactured Home Park Lots Recreational Vehicie Park Site: Traffic Si� nal Standard $5 Sup lemental Fee $20 Transformers u to 10 KVA $10 Transformers over 10 KVA $ 20 Transformer I Power Su I for Si ns / Outli ti $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 Trips @ $20 Investiaative Fee total fee sL$20) I �[ .�� I I inspec[ed the electrical installation described herein on Ne dates stated: � ° 2 �d�S'1 S ial Ins on $.31 per Mile THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS � � �� ` _ - .. � �i�� I I� f� �� (�� ) ��(�� 1 8 2 0 4 7 8 4 Date: Rough-in Inspection Required? es ❑ No Inspec6on Other Than Rough-In: ❑ Ready Now [�tlVtlr�all� // � • You must call the inspector when ready! Date Ready: I ceRify that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at Job Site SVeet Address Cily�. � 7 (o� � �r4-� �'!''i�� c�• � Township �� SecUor� Range . Fire No. County Name , ��,.., � �.�� .�.�,�, ��„�r..��,�„ �/ / Company N me � ConVad �Wk �l�' ` ( �� ddress (Contractor, Company or Owner Perfortqing Installation) ! l � %/ C G`-z--�r ,� ��Ce �/ gnature (Contractor or Owner Perf� In IlaUon� �__,___�—� -- - nnua nu necr nc vc� i nw rnev eneon nv ci orro��T.. Please Provide Two (2) Phone Numbers Including Area Code � 1 � / License Number Master Electrician or Power Limited Techni� I License Number �3 CJd-3 � � Please Provide Two (2) Phone Numbers Including Area Code (�)��z��/.( )