P - 75942REQUEST FOR ELECTRICAL INSPECTION � �..
� 1��� o- 413 � Minnesota Boar�f Elect�icity ;
1821 UnNersity Avenue Suite 5-128, Saint Paul, Minnesota 55104
(651) 642-0500 TTY/MRS 1-800-627-3529 www.edectricity.state.mn.us
D�cn'be -using the back of th ayhite copy'rf nec�sary - the vrork covered by this request:
�� � �� - e�.�� p�,�,r'
0 to 2W Am re$5
Above 200 Ampere @$10
tM, COMMUNICATION, REMOTE CONTROL, SIGNALI
�UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.5D
ADDITIONS TO THE GENERAL FEES
TIFAMILY DWELLINGS PER UNI
3 to 12 Units @$50 Per Unit
Each Add'fional Unit � $25
OTHER ADDITIONAL FEES
Lightin .Retrofit @ $.25 sr FoRure
Center Pivot Irtigatlon Boom @ $40
Manufadur� Home Park Lots $25
Recreatlm�al Vehide Park Sites $5
Se Bond Ins 'on $20
Special Ins 'on @ $30 {�r Hour
S' Irts on $.31 r Mile
S INSTALLATION MAY BE ORDERED
I IIII II III II I�I li �l II al I1 II! ��{I �I �� I�
18204131
Transfortners over 10 KVA a$ 20
Transfomrer / Power Su � i for Si ra / Outline Lic Minq $5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Prnaer Supply up to 500 Am�res, /W
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Addi�onallns 'onT' $2p
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Imrestigative Fee
Reins on F� $20
TOTALFEE -�,�`
(minimum total fee is $20) �.�1.�� ����
nusarsFnwnusrECronugow.r � _ ��
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I hereby certfy tl�at I Nspeded the elearical h�stalhatlon des�nbed herein on Ne da
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NECTED IF NOT COIUIPLETED WITHIN 12 MONTH:
Fa� oF-ice use or,tr
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�� Rough-in Inspectlon Required7 ❑ Yes ❑ No Inspection OtherThan Rough-In: 0 Ready Now ❑Wi� Call
7� 10 ��� You must call fhe Inspectar when ready! Date Ready:
I certify that I am the � LICENSED CONTRACTOR ❑ COMPANY �OWNER and hereby request inspection of the electrical work at
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ELECTRICAL INSPECTIONSp ` ° "'" PERMIT N0. �- �_' - - —
CORRECTION ORD,ER —., DATE �� �` ;s`�-=- -���=�` '��
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Installer of Wirfng ` " y"`� `y � `?` `"
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� OwnedOccupant !; , i1 _ = � � :`.�"� =< ''-, �� Job `�.•`,
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Properiy Address � ` �'� �''� Zip
The foilowing items are deviations from the accepted standards of constructlon et the above described
premises. Numbers after each ftem are applicable NaUonal Electrical Code Sectlons:
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Correct the noted deflclencles end: ,' �;y ,;�� y,�; �-f,, r-� rr; -::� ,-�` �-F.
❑ Notl�y inapector for relnspectlon betore c vering wiring. �, �> �,�� `,� :�-�
�=:He-inapectlon will be made et tlme ot �Inapectlon. �-' `� p � q ,� K � � ,,,� �r „��,'�,�_
� S ign en d re tum t h le t orm to Inspecto,r w hen correc t ione heve b een ma de but no leter
then (Dete:) ` �' 6
Signature of Installer
Ro� rt_ Cl�a�n
1586 E. Sextant Av . Date of Compliance
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Maplewood, MN 55109 '
Call 651-777-7885 for Reinspec n- 7:00 - 8:30 a.m.
Monday - Friday except holidays.
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