P - 76989��� REQUEST FO. ��TRICAL INSPECTION � �
1� Q� f1 � 2 8 7 Minnesota Board of Electricity
v�Y 1821 University Avenue Suite S-128, Saint Paui, Minnesota 55104
' (651)�42-0800TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
Describe -using tlie badCof the white copy if necessary - the wark covered by this request:
/ POWER SUPPLIES
Above 200 Am ere $10
ALARM, CAMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Addidonal Unit � S25
OTHER ADDITIO
Liahtina ReVofit �i! $.25 aer Fixture
Mile
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18202879
Outdoor Li htin Standard �$t
Trafic Si nal Standard $5
Su plemental Fee $20
Transfomiers u to 10 KVA b10
Transfonners over 10 KVA $ 2(1
Transfortner / Power for S' ns / Outline L' hti S5
ONE 8 iW0 FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Suppy up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit ��0
TOTALFEE
total fee IS $20) � �. SO
THIS ME� FOR IILPECTOR USE 0lLY
st��sCri��refi � `G
d the electrical in on th dates stated
, �� � onre
.. ���� �:�� ��
��--'-�,l a-%/ - 07
!D IF NOT COMPLETED WITHIN 12 MONTHS
I�EC'D J U N ��= ����,�200T
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�� Rough-in Inspedion Required7 (�Yes ❑ No Irupection Otl�er Than Rough-In: ❑ Ready Now (�Nid Call
�—�'� �i � You must call the inspedor when ready! Date Ready.
I certiTy that I am the p LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Site SVeet Address Cily
� 8� c�C��v,qv� �� � � ��%
Trnmship Secbon Range Fire No. County
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OwnedOxuoant Name Please Provide Two (2) Phor� Numbers Indudir� Area Code
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ise Number Master Electrician or P
License Number
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rYLvv �'QZ S"'
Please Provide Two (2) Phone Numbers I
(�t)�g3-�Y� �bSs�)