P - 76991..
I REQUEST FOR ELECTRICAL INSPECTION
2� O 4 o'�e 8 7 9 Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 -
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
i ' the badc d the white copy 'rf necessary - the work covered by this request:
I �.�` IMOV, rC.�¢� . �(
,- GENERAL F Outdoor L' h6 Standard $1
SERVICES / PO ER SUPPLIES Traffic Sianal Standard � S5
:UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Uevice or Apparatus @$.50
ADDITIONS TO THE GENERAL f
TIFAMILY DWELLINGS (PER UNIn
3 to 12 Units ��50 Per Unit
Each Additi�onal Unit � $25
' na
OTHER ADDITIONAL FEES
L�Ming R�'it @ S25 per Fixlure
Center Pivot Irtiaafiai Boom id 540
7ransfortners wer 10 KVA a ZO
• Transfortner / Power Su for ' ns I Outline L' h6 ;5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Indudes ihe Service andlor Power Supply up to-500 Amperes, All
31GNALING Circuits a� Two Inspection Trips Ea� DweNing Unit � S80
Additia�all ' Tri =20
Inves' tive Fee
:ES Rei ' Fee S20
TOTAL FEE �
(minimum totai fee is $20)
T16 RREA Fqt W5PECTOR USE 0lAY
��Y �N tl�et I inspected tlie elearical nstallatlon desaibed 1� on tlie d�es staOed:
ROIMXM . pp7E �
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�ection S30 Per Hour ���o � o�re
�edion Q a.31 per Mile �Q ^ 2-� c
�LLATION MAY BE!ORDERED DISCONNECTED IFNOfCOMPLETED WITHIN 12 MONTHS __
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�� Rough-in Inspection Required? ❑ Yea �vo In
/ �, spedfon Other Than Rough-�n: � Ready Novr iN Caall
�� ^� ���O You must call the inspedor MAien ready! Date Ready:
I cefify that I am the (�LICENSED CONTRACTOR � COMPANY ❑ OWNER and hereby request inspection of the electric�l woric at
Job SiGe Street Addreas �Ry
IyJ C��Z�?s �-_ �R��y
Name Plaase Provide Two (2) Phone Numbers I
k.� � �hs..s�.� �6�1 s o9 ( )
Electrical t)dlily Address
�anY Name ' N`+ Contradw License Number Master Electrician or P�
`�C 1^ � u � Q � License Number
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Contredor, Company or Owner Perfortning In�allation)
C ��tc�� vow+� � . V. t� 5 t6
Nure (ConVac[or or rming Insiallation) Please Provide Two (2) Phone Numbers I
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