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P - 75825REQUEST FOR ELECTRICAL INSP.ECTIO�V 1����` � 12 5� Minnesota Board of Electricity 1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104 ?�- `' (651)642-0800TTY/MRS 1-800-627-3529 www.eleciricity.stnte.mn.us Describe -using the back of the w�hite copy ff rtecessary - the work covered by this �equest: �i�slt (l ��rJ GL i�G�de� �'eG�(OIL� p�po��, GENERAL FEES Outdoor Li hting Standard $1 SERVICES / POYdER SUPPLIES TraRc Signal Standard $5 0 to 400 Am re@$25 P Sup lemental Fee @$20 401 to 800 Am re$5D Transformers u to 10 KVA $10 Above 800 Am re$75 Transformers over 10 KVA $ 20 CI CUITS / FEEDERS Tiansfortner / Power I for SI / Outl'me Li htin $5 0 to 200 Am re$5 ONE 8 TWO FAMILY DWELLINGS, EACH UNIT Above Z00 Am $10 Includ� the Service arid/or Power SupPty up to 500 Amperes, M ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwellir�g Unit @$80 CIRCUffS, CIRCUITS OF LESS THAN 50 VOLTS Additianal Irrs 'on Tri $20 Each System Device or Ap ratus Q$.50 ImesGgative Fee ADDITIONS TO THE GENERAL FEES Reins on Fee $20 MULTIFAMILY DWELLINGS PER UN TOTAL FEE � 3 ro 12 Units @$50 Per Unit (minimum total fee is $20) �J ,�� Boom I hereby certify that I fnspected tl�e electrical hista➢eUon desafbed frereN on tlre detes eteted: -0�I Spedal I on @$.31 r Mile THIS INSTALLATION MAY BE QRDERED DISCONNECTED IF NOT COAAPLETED WITHIN 12 MONTHS Ft�R OfFICE USE ONLY IIuI�WUllllllllll��lll�u�lllll��l� � � � 19341254 `����� ��� �' Rough-in Inapectlon Required? ❑ Yes o Inspection Ofher Than Rough-In: Ready Now ❑VYm CaA ' d�Q � You must c:aU the irrepector when readyl Date Ready: � 3'� � I certify tfrat I am the CENSED CONTRACTOR ❑ COMPANY ❑ OWNER and herebylequesE i�spection of the ele.ctrical work at �ob stce addr�s ° c�ty � � � v� IV E �_ ��C Townsh�P Secdon Range Fire No. Cou � � �G �vn O�aM NamO Ple� Provlde Tv� (2) hnrte N I�ludirtg Area Code � �� �' le� � � ��' S�%�) Name ma�er Frecmaan or License Number ��:.� iLti.�l�i'�it\Inl/'!f� �l �iI'I'FLI, %�1"/��'�/ll�����i r� � 1._ .� ' �i ��.'�'.�. �� , � 1 �.� • ° • � . ����a� _ . .n..