P - 76201REQUEST FOR ELECTRICAL INSPECTION -��°'
2� Js "�t 0� 9 2 4❑8 821 University A en e 3uite 5-128, Saird Paul, Minnesota 55104
n—� (651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.staJe.mn.
Desc j,pe -using�� the je� py'rf n� ork cov/�this quest: 1 �.����� ��
�9 � 0 1'
I SERVICES / POWER
CIRCURS/FEEDERS
0 to 200 Am ere a$5
Almve 200 Am ere a$90
ALARM, COMMUNICATION, REMOTE CONTROL, SIGI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A paratus (a� $.50
ADDITIONS TO THE GENERAI. FEES
3 to 12 Uniis
Home Park Lots
� THIS INSTALLATION MAY BE ORDERED
I I�I � I� �I III N fil II �II II �I � I� II �I �� I�
21409248
Supplemental Fe.e @ $20
Transfotmers u to 10 KVA �$10
Transformers over 10 KVA @$ 20
Transfomrer / Power Su I for Si ns / Outline Li hti $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two InspecGon Trips Each Dwalting Unit @$80
i�iw�ree
(minimum total fee is $20) � � � ��
Tf �3 AREA FOR MSPECIOR USE p�O.Y
I hereby certify that I inspected the elecMcal i�iellatlai descnbed hsrein on tlre datea stated:
awc�w nnh
Fwuus�cnon - - oare
� ' 1 ��
�c�;:�.s:ce usc r,�F,� ;
��ro J u �. - s 2007
��� ��a-�'
��� Rough-In InspecUon Requlred9 ❑Yes No Irrepection OtherThan Rough-In: eady Now OWDI Call
�' �" Q You must call the inspector when readyi Dats Ready.
I certify that I am the LICENSED CONTRACTOR ❑ COMPANY O OWNER and hereby request inspection of the electrical work at
Job Site Street Address
� o �a`�a �. S?`' � E /30 ' ; �l
ownah(p Section Range FUe No. Co _
'/4hb �
� / Please Provide Two (2) Phone Numbers Including Ar
°f" 7�v i'ri� � ) � )
/ s/ � dd ` �'�.�� � � �� / " 1 l.�
i CoMredor License Number Master EI cian or P r Limita
� i°es / i ( � �Q� (� �O � Licenae Number
Company or Owner Performing Insfallallon)
� � °,� �., �S �- nl � ,' 1�1 � 1..5 i�7 �1.s-s''�l�
0
.