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P - 76076REQUEST FOR ELECTRICAL INSPECTION °�,: � 1— O��- 2 81 0 Minnesota Board of Electricity 1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104 � (651)642-0800TTY/MRS 1-800-627-3529 rovww.electriciry.state.mn.us 'H� '"� Describe -using the k°F the�/C.+ coPY ff�4' /�the work�red� reQue.at: �� (O G FEES Outdoor Lightin Staridard @$1 I SERVICES/ ALARM, COMMUNICATION, REMOTE CONTROL CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Each Svstem Device or Aooaratus Ca� $.50 untt Cer�ter Pivat Traffic Signal Standard � $5 Su ��lemernal Fee @ $20 Transformers u to 10 KVA $10 Trartsformers over 10 KVA $ 2(1 Transformer I Power Su I for Si ns / OuUine Li hUn $5 ONE & NUO FAMILY DWELLINGS, EACH UNIT Includes the Service antllor Power Suppty up to 500 Amperes, M Circufts and Two Inspec�on Trips Each Dwe�ing Unit @$80 tatal fee is I hereby cerWy that I Napected fhe electrfcal ir�atlon desatbed frerefn on ihe da�es a�ted: 3�P �� 5 " I�pe,c�on @ $.31 r MUe THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITF �OR OF�ICE USE �N! Y ��� ��Ill����l��l�f��all�lllll�llin�l� �i-, 18762815 ���(.�°����� � � ��' Rou h-in Ins � g pectlon Required? ❑ Y� o Inspecdon Olher Than Rough-In: ❑ Ready Now �I Cap �' ��� You must call the inspedor �ifien ready! Date Ready: I certify that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspectlon of the electrical work at ��✓ ✓ / ��l77� �7�> C� � �t-�, � � m� Comra r or Ow BACK OF YELLOW COPY l�� --e'ff`l��j��( f� �. /�il � Contractor Llcer�se Number Mester EI� �, /�,/J��--� Uc�erise Nur C, 7(l/� , �lation> �� �� �J ��� istellatlon) lease ProNde Two (2) Phone � )7�- 3� 80ARO OF FI Ff;TRIrT' f`f1Pv � r�� �