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P - 78252REQUEST FOR ELECTRICAL INSPECTION 1� 4 71 �� 0 5� Minnesota Board of Electricity 1821 University Avenue Suite S-128, SaiM Paul, Minnesota 55104 � (651) 642-0800 T'fY/MRS 1-800�27-3529 www.electriciry.state.mn.us ❑ NEW EMODEI O ADDITION REPAIR Describe -using the back of the white copy if necessary - the work covered by this request: GENERAL S Outdoor ' tin Standard S1 SERVICES / POWER SUPPLIES TraRc Sional Standard � 85 l �� ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Each S tem Device or atus $.50 ADDITIONS TO THE GENERAL FEES MULTIFAMILY DWELLINGS PER UNI 3 to 12 UniLs �$50 Per Unit Each Addifional Unit @ $25 OTHER ADDITIONAL FE L' htin Retrofit 5.25 r Fixture Center Pivot Irri a6on Boom $40 Manufaclured Home Park Lots � E25 I THIS I lill II III II III II Ili II il I II I II II III li III �� I�II ONE 8 TWO FAMILY DWELLINGS, EACH UNIT Includes lhe Service aridlor Power Supply up to 500 Amperes, All CircuiLs and Two Inspection Trips Each Dwelling Unit � E80 80 TOTAL FEE I � (minimum total fee is $20) yQ TMIS RREA FIXIINSPECTOR USE WY I hereby cerfify thffi I inspecfed Ihe decb'ital insfaY�pn described herein on }he daRes s�0ed: � �#.°?a 5 '� 14716054 �-�OO`� ` ���1b r�3t�� `�p,sv Request Date: Rqigh�n Inspection Required? � No Inspedion Other Than RougMn: ❑Ready Now I Call � i You must call the inspector wF�en ready! pate Read , Y I certify that I am the �LICENSED CONTRACTOR ❑CONIPANY ❑ OWNER and hereby �equest nspecfion of the elechical work at; �O y�nge � rse no. nty • - - a 6l Please Provide Two (2) Phone Number(s) Induding N / � � / � / Su Address o �� v. � Contrac�or License Number Master Electridan a Pawer LimiDed uoense Mumoer � /� ' 7 pany or Owner Perfarming nsfallation� /K �� idor. CamPe�Y a ' Irstellation) Phme (s) /�v�� � OF ELECTRICITV COPV EB-00001M11