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P - 76288• I�EQU,EST FOR ELECTRICAL INSPECTION 1�� J�- 518 J❑6 Minnesota Board of Electricity ��„ 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 " , (651) 642-OS00 TTY/MRS 1-800-627-3529 www.edectricity.state.mn.us Describe -using the back of the white copy'rf necessary - the work covered by this request: �� r��c� s�vE� �s s��-c� SUPPLIES A�ve 200 Am ere a$10 ALARM, COMPdUNICATION, REMOTE CANTROL, SIG CIRCUfTS, CIRCUITS OF LESS THAN 50 VOLTS Each System Dewce or Apparatus @$.50 ADDITIONS TO THE GENERAL FEES to Park Lots ( Park Sites Trefflc Signal Standard @ $5 Su plemental Fee @ $20 Transformers u to 10 KVA $10 Transformers over 10 KVA @$ 20 Transformer / Power Su I for Si ns / Outline Li hBn $5 ONE 8 TWO FAMILY DWELLINGS, EACH UNIT Includes the Service and/or Power Supply up to 500 Amperes, All Circuits and Two Inspection Trips Each Dvrelling Unit @$80 Additional Ins 'on Tri @ $20 Investigative Fee Reins ction Fee @ $20 TOTALFEE (minimum total fee is $20) �� `� rwsu�aFOa msaecroa use oM.r I hereby certliy thet 1 inspected the electrical installaUon described herein on the dates stated: � c�i�� THIS tNSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS �II+ III I�CD JUN 14 200i ��I��N��I�� N��I � �79751$� ��i�%'��-�i(�('�� I"°`°' Rough-in Inspection Required7 ❑ Yes �] No Inspection OtherThan Rough-In: [�Ready Now ❑WIII Call �`� �- �%�� You must call the inspector when ready! Date Ready: t i�rtity that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspecfion of the elecVical work at Jpb Site Street Address C�y �1�}4 h!E bTN Si" FF:TDLEY (�ih� �54,:f� �T4wnshiP Section Range Fire No. County �wnenuccupanc rvame Please Provide Two (2) Phone Numbers Incluc FLEFtf�C�Eia KETiH �� ( � ( � F,lectrical Utility Electripl Utility Address � CEL EhlEl"�;Li1' ConUactpr / Company Name Contractor License Number MasTer Electrician or Power License Number HL�hlT ELECTR�C COF;��7�ra i iLh1 rA �)�JB�:� Nlalliny Addresa (ConVactor, Company or Owner Performing Installatlon) s=�.?'S'va' ��I?1-6l.��t"�.L�L R�H}q �1HZ1`71 ��I�I�L9 1�� l.l� Autlmrl,�d Slgneture (Contractor or Owmer Performing Installation) Please Provide Two (2) Phone Numbere Inciuc �c�5� ��6'L�1i � � IMSTRI}CTIONS ON ACK OF YELLOW COPV anewn nc Fi crrwirirv rnov �e . Code