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P - 75452REQUEST FOR ELECTRICAL IIVSPECTION °' p 1��o � 2 6� � Minnesota Board of Electricity 1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104 ° (651) 642-0800 TTY/MRS 1-800-627-3529 www.elech^icity.state.mn.us riba -using the back of the white copy'rf necessary - the work covered by this request: � C�7�'-!N ���P�� Oi`� uQ� fL� �� 1�'� f�?/�2 �. GENERAL FEES Outdoor Liphtinq Standard na. $1 0 to 400 CIRCUITS OF LESS THAN 50 VOLTS iystem Device ar Apparatus @ $.50 ADDRIONS TO THE GENERAL I Center Pivot Irtigation Boom � Manufactured Home Park Lots S e.cial Ir�specUon �$30 er Hour S'al Ins on @$.31 r M�e THIS INSTALLATION MAY BE ORDERED D I �III � ��! 0 �i� �I hi � �II II �I II I�� a I� 0� �� 18202689 Transfomrers over 10 KVA $ Zfl Transformer / Poxrer Su I for Si ns / OuUine Li Yfin $5 ONE & TWO FAMILY DINEWNGS, EACH UNIT Inctudes ihe Service and/or Power Supply up to 500 Am�res, AII Circufts and Two I�pectlon Tdps Each Dwellirtg Unit @$80 Additional Ins 'on Tri $20 Imestlgative Fee Reins on F� $20 TOTALPEE (minimum total fee is $20) I� 5— NOV ,��� ��Y �C� d 2008 r�v�, I hereby cerdfy that I inspeded ti� elec�Ical mstalledon des�d i'reretri on s�ted: aattm w on� � ,3�z- �' F'JkOrF'i'EUS� LY C.G� � ( �I � I �-r Rough-in InspecUon R�uired? �Y� ❑ No Inspectlon Othar Than Rough-In: ❑ Ready Now�YVN Call ' �� You must call the inspedor when readyl Date Ready. 7 fhat I am the ❑ UCENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at Street Addreas City ��1�' 7Y � 1 `IM� 1 �'� � � Section Range Fire No. CouMy ' /� iador, Company or ��a �� Please Provide Two (2) Phorre Number \ws�7���� \ �� �se Number Master Eledrician or License Number Please Provide Two (2) Phone Number \ � l'tl��� \ �1