P - 75639Minnesota �pa
443 Latayeite Rt
St. Paut, MN 55
Phone: (651) 28
TTYtMRS: (65
arw�v.2�'i �
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�ddress of Irts�
�6i3
haner Name
L•
of labor and Industty
798
Reguest for Electricai
Rough-in Inspectfon Req�ir�?
Gontractor Must Sc�eduie Ail Rou
on - Street
�l��. l �ivt JUE.
n� r•� r�rn r�din es
Owner T8lephone Numb�r(sj - in
f�lG3- 37� - ��_
contrac�or Name
BRONSON ELECTRIC !NC
Contractw TeFephone Number
(320} 761-2625
Atea
Gsl- 717- 7��3�
:tion - One Family Dwe
Yes Sirtgle Inspection pther T
�tians Gontfactor AAus1 SdtEdulE
City/Township
rr 1
PTOJBd PtPOR
�' Sif.�07�
Contredor Ma�l�ng Acfdress
251 OANORA PL ST, CLaUD, MN 56301
•+�u�v��cesu a�yna[tsre Gor►tractor Lioer►se Number
._� -����_ CA040�7
Fee Caicuia#ion
New Home or Ass�iaited Structure
Plew [7rovelling Servic�lPo�a�r SuPp1Y �- 400 ampere @1$35
New Dwelting SenripeJPower Suppiy 401 - 800 artrFsre �$6p
YVfiN V Il1.iY��� "
(It18dd1�10(1 t0
30 A C� S6 Eme
t�tached Garage or Other Associat�d Structure
New ServicelPower Supp4y 0- 400 ampere �$35
New Feeders/Circuits i 1 C� $8 Each
,l�na kac
��T� N a�
Structure
� Ready Now
� Wifi Scher�eih
Existing Home/Structur+e Rem�1e1 or Addition �-
Mew Sarvice/Powar SuPPh� 0- 400 ampere �$35 �
Alew Servic�/Power SupPh+ 401 - gpp ��p8re � ggp __ .�.
-----__-------__—___----- --- ------ _ _ __�.__
�fE+m/Extended Feeders/Circuits - Up to 15 F�cbers/Circuits
i ) Feeders/CirCUits C�_$6 Each ar 16 to 3U ��trtn �
Detach�d Garage or Other Associated Structure
I Ne�►+ Servic�e/Pawer Supp1Y 0- 40D ampere � S35 `-
NewlExtendetl FeederstCircuds i�) G$S �ach A --
Recon�cied FeederslCir�uits ( } � g2 Each -.
—
i
OtheriSaec.ifv! � --'�".
_._.__.,_�_____..___ ._---�---.
T�ta! (the fee cal�ulated above or S35 muhiplied Totai (the fee ratcutated above or $35 multiptied � �..
by the num�r o! r�quued ms�ion Mps, by the number af !
whichever rs greater) ►equued inspection trips, ; O
wh�cttever is gfe8tsr) i
Re4uests tor E�Ctntcel i�actla� �REI) wNh a fe� of 5260 or i9as explre 12 mcfrrths frmr+ the R
U►e 3 2 anontl� per9ad ar suhmit srtotfi8r RE! tha't inCludes !he i�tspeedaa Pee tor t1� ure� � date. Fhe CorNraetor must have tlee w�k CompleteQ
QmP�st� work. t�pe�ctlon te� t� n� carry over h�um a� R o
A servtCe cha ��er.
rge or 33o wtu ee addea ror �n dishorto,�ed cl�ectce. �1f/�
1 herebY Ithat�tily in�pecied the electnc�l instaliaUon herem on the detes ara►� -- � N 4' /
Rough - !n inspeqian(sj
� �-
i ors ma�ena� can 1�
TOD (661) 297-4198.
REI U2 {6lQ7)
Date -• o..,........�..�. .,�, �y �,>
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'� � �a+'9e Prfnt, BraUle or on a tape, r� req�, ceH 1-8Q0-3�2-8354 (d!' -DU+ Vo(ce or
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