P - 76282� REQUEST FOR ELECTRICAL INSPECTION ��
1�� 7�- 5 2 3 I v I Minnesota Board of Electricity •;
�_�_� 1821 University Avenue SuRe S-128, Saint Paul, Minnesota 55104
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. (6�51) 64a-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
-using the back of the white copy if necessary - the work covered by this request:
E;�CEL EhlE�;C;Y SA►IEF�'5 S4ITTCN
GENERAL FEES Outdoor Lighting Standard @$1
SERVICES I POWER SUPPLIES Treffic Si nal Standard @$5
0 to 400 Ampere @$25 Supplemental Fee @$20
401 to BQO Am re $50 Transformers u to 70 KVA $10
Above 8 Ampere @$75 Transformers over 10 KVA fa� $ 20
L
2�OAmpere @$10
1MMUNICATION, REMOTE CONTROL
CIRCUITS OF LESS THAN 50 VOLTS
Per Unit
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circufts and Two inspection Trips Each Dwelling Unft @$80
Fee
(minimum total fee is $20) I ' 0�{1
I hereby ceA'rfy Mat I inspected the electrical installelion d�cribed herein on the dates stated: j
- ---- — - __ _ _ ---- - --
Se raie Bortdin Ins 'on $20 � • � ! "�
6pecial Inspection @ $30 per Hour �QiED �^B^"�0 �T�
Special Ir�pectlon @ $.31 per Mile
HIS 1NSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
I�C� JUN 14 2001
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�'�"'' Rough-in Inspection Required7 ❑ Yes ,❑ No Inspection Other Than Rough-In: [�,Ready Now ❑ Wfll Cell
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�0' �. �. r��! You must call the inspector when ready! Date Ready:
I c�rtify that I am the [�7 LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Site Street Address C�y
66�� i�dE FF;IDLEi' ST Ff�TL�LEr (�i� 55���
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Electrlral Utllity Electrical Utility Address
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Corttrecta 1 Company Name Contractor License Number Master Electrician or Power Limited
License Number
NUhIT ELEGTF�IC CDF;F'OF;A�"TOhI i'A O(�88�
AAailing Address (ConVactor, Company or Owner Performing Installation)
�3�}C� TE�i�'S3��FiIf�L f-i6ADq SAIhIT F'€1ULq i�h( 55i14
Authotiag�J Signature (Contractor or Owner Perfortning Installation) Please Provide Two (2) Phone Numbers Inctudin Are:.
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lN87AUC770N9 ON CK OF YELLOW COPY BOARD OF ELECTRICITV COPV F[irmnn� e_�c n� omn