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P - 77207REQUEST FOR ELECTRICAL INSPECTION 1— 7 31 � 14 0� Minnesota Board of Electricily 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 (651)642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us 0 NEW ❑ REMODEL ❑ ADDITION REPAIR Describe -using the back of Me white copy if necessary - the work covered by his request: e�v�'��cri�,`c /f'e� T G.Z"f�i�ac� h 8a.s��,�ti7 dd %�' ���P, �ENERAL F S Outdoor Liahtina Standard (d $1 CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS to 12 Units ca $50 Per Unit ach Addi6onal Unit @ $25 Hour Mile uil il�l� i! li! II lil I!!'! il III II ill II III pl� i�l 1 7 3 1 1 4 0' Transformers u to 10 KVA $10 Transformers over 10 KVA �$ 20 Transformer I Power Supply for Signs / Outline Ligh6ng @$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT Includes the Service and/or Power Suppiy up to 500 Amperes, All Circuits and Two Inspection Trips Each Dwelling Unit @$80 Additional Inspection Trips @ $20 Investiga6ve Fee ReinsDection Fee (�a $20 d TOTALFEE (minimum total fee is $20) ��� s � iH15 AREA fOR INSPECiOR USE 0llY I hereby certify that I inspected the elecOrical install�on described herein on the dates stated: ISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS _ I - �-��" ��� � �� ecequesi va[e: Rough-in Inspection Required? LJ Yes iCJ No Inspection Other Than Rough-In: �eady Now ❑ Will Call os �� You must call the inspector when ready! Date Ready: y� I cerMy that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and her�by request inspection of the electrical work at: Job Site Address (Street, Box, w Route No.) =City Zip Code �'t l/ 6?r'� ��e AJ� �. �/�i�le Y Sue� �.,- /T . fa ON BACK OF VELLOW COPY I (�-��o�s3�( ) ddress ConVador License Number Master Electridan a Power Limited Techn License Number �) e / Ilation) Phone (s) I � ELECTRICITY COPY EB-OOOOtA-14 8.1.