P - 762811 7 9 7 5 2 6� � REQI�EST FOR ELECTRICAL INSPECTION
� � Minnesota Board of Electricity � ;
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
� ' — ' , (651) 642-0800 TTYlMRS 1-800-627-3529 www.electricity.state.mn.us
-�ing the back of the white copy'rf necessary - the work covered by this request
�;�cE� ��a���r ��+��� • s st�T i c�
GENERAL FEES Outdoor Lighting Standard $1
SFRVICES / P07dER SUPPLIES Traffic Sipnal Standard (m $5
}MMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS OF LESS THAN 50 VOLTS
ivstem Device or Aooaratus C�D $.50
Unit @
)DITIONAL FEES
fixture
Speci�l Inspection @ $30 �r Hour
SpeCial Ir�s ection @$.31 per Mile
THI$ (NSTALLATION MAY BE OF
I I!� i�l� II lal II �I II I� II �I a�I N!I� I�I I UII
,�'7975269
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
TOTALFEE
total fee is $201
�o :�Q
Nffi I inspected the etectriql installation da5cribed herein on the dates
DISCONNECTED IF NOT COMPLETED WITHIN
RE�D JUN 14 2001
�iG� � 7 - �! o C� 1
_2/_e71
�8' Rough-in Inspection Requlred? ❑Yes &�No Inspeclion OtherThan Rough-In: �Ready Now OVdill Call
�! �. .� ,F� I� You must call the inspector vfien readyl Date Ready:
I c�rtity that I am the C;] LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Site Street Address City
7�81 I+�E HF�`iES ST FFiT�}LEi` (���� �i54''a�
Todmship Section Range Fire No. County
Owner/Occupant Name Please Provide Two (2) Phone umbers Including Area Code
�C{-Il�II�T PfiUL � ( � ( �
Electrical UG{ity Elechical Utility Address
�C�� �{��E��.7'�'
Co�redOr / Compeny Name Contractor License Number Master Electrician or Power Limited T�hNcian
License Number
HUh�T ELEGT�IG COF�F��7fiATlni�l ��A �083�
Mailing Address (Contractor, Company or Owner Perfortning Installadon)
b34Q IE%�ill"OfslrtL fii3ADq SATf�IT N'AULq �l�! �511�
Apthorizeti Signature (Contractor or Owner Perfortninp InstallatioN Please Provide Two (21 Phone Numbers Includirm Area Cade
\ /