P - 78183(� REQUEST FOR ELECTRICAL INSPECTION
1�� J 0- 2 3 3� Minnesota Board of Electricity
1821 University Avenue Suite S-128, SaiM Paul, Minnesota 55704
C�S�� (651) 642-0800 TTY/MRS 1-800�27-3529 www.e[ectricirystate.mn.us
❑ NEW REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the work covered by lhis request:
C c�so S 1- � - '?�'gs
�ENERAL FEES Outdoor Liphtina Standard � St
tM, COMMUNICATION, REMOTE CONTROL,
;UITS, GRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL F
fIFAMILY DWELLINGS (PER UNIn
3 to 72 Units @$50 Per Unit
Each Additional Unit � E25
�
�allns �on E30 Fbur
Special Inspection @ 5.31 per Mile
� THIS INSTALLATION MAY BE ORDEI
I� U�I Iliil IIIII IIIII IIII� IIIII IIIII N� I�
15902331
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Cirouits and Two Inspection Trips Each Dwelling Unit � E80
TOTAL FEE I �-f'�
(minimum tohal fee is $2()) � ��'�
iN5 NIFA FOR MSfECTOR lbE OIIY
� �1lfEbY � i�l� � IIIS(IBC� tl1E C�CCtrIC3� 1115i��Of1 �I� �1P1G11011 i�lE 4� �:
�
2 /���"
�uG �/- C,�`y� �j,S U
Request Date: Roughin Inspec.tion Required? ❑ Yes Inspedion Other Than RpigMn: �Ready Now I Call
';3 1" 6 You must call the inspector when ready� pete ReadY .
I certify tliat 1 am 1he�CTCENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspeciion of the electrical walc at:
�� �,�,�� c�.�. �. a�,� �., c� �� � � S�4 3�
l� 1. � �� '
SeUion TownshiP Range Fire . County
_ c31� o �v�a �
�: nease rroviae rwo (z) Phone Mumber(s
(���'rG� ��f�9 ( )
Hatn La�.1�Al�i £�3�14� � i7�' �'
�tr�� irg hstaNation)
1
, �
� (�/ , � orming � uaaon)
�c oF corr aouro e�c�wcm coar
Masier oecmaan a
License Number
I
E&00001M14 8A.2002