P - 76360REQUEST FfJR�LECTRICAL INSf�ECTIO�IV
� � S � (1- � � � � Minnesota Boarci"of e�et�icity
a% 1821 University Avenue Suite S-128, Saint Paul, Minnesqta 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
Desaibe -usirg ihe badCof the whfte copy'rf"� ry- the work covered by this request:
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GENERAL FEES "�• Outdoor l� htl Standard $1
SERVICES I POWER SUPPLIES . Traffic Sianal Standard C�D $5
Above 200 Am ere S10 �
ALARM, COMMUNICATION, REMOT CONTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
3 to 72 Units � i50 Per Unit
Each Addidonal Unil @ $25
OTHER AD
Liphtinp Retrofit � 5.25 cer 1
ction E30 erHour
xtion @ $.31 per Mile
1ATION MAY BE �DERED C
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18202713
Transfomiers u to 10 KVA �$10
Transfomiers over 10 KVA $ 20
Transfomier / Power Su fw S' ns / Outline ' hti $5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Indudes the Service andlor Power Suppty up to 500 Amperes, All
Cirewits and Two Inspec6on Trips Each Dwelling Unit @$80
Additional Ins 'on Tri s S20
InvesC tive Fee
� Fee $20
3 TOTALFEE
(minimum total fee is $20)
IS INSPEC R U �
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I hereby certify ihffi I inspecled Ihe electrical instaAatbn d� Vyesabed� herei�t"on the d�
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"a`e' Rough-in Inspection Required? �Yes ❑ No I Inspedion Olher Than Rough-In: ❑ Ready Now ❑ WiN Call I
3���� O� You must call fhe inspector when ready! Date Ready:
I cefify that I am the 1�UCENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspeaion of tlie electrical �k at
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License Number A,
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�ignature (c:omractor or owner Pertormi� Installation) Please Provic
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prope�ty qddress E.; 7 � � %�c u .e �a � % � /�� � �p = n < < �
7he ToROwin� itartis are dovi4dons from :�+e accepted standards of construcUon at the above described
pro�nises. Numbers atter each IQem ero applicable Natlonel ElacMcal Code SecUons:
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COfia4tilN IIOI�d �IICNi alld:
O NotHy insp�c�or for rolnsp�ction bdon covKM� wirin�.
RNnsp�ctlon will b� m�N �t tlm� of nsxt inap�ctfon.
Si�n and rNum thb brm to. �nsP�c�or whan oorr�otions iuiw bNn m�ds but no I�br
tMn (D�tr.) S ° l 1 ' � '7
Signature of Installer
Robert Clauson
1586 E. Sextant Ave.
Maplewood, MN 55109
� ,�,� g-�o�
-777-7885 for Reinspection - 7:00 - 8:30 a.m.
Monday - Friday except holidays.
RC-01