P - 76067REQUEST FOR ELECTRICAL INSPECTION � �`
�� 01 �� 415 � Minnesota Bc�ard of E�ctricity ;� �
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.edectricity.state.mn.us
De.scribe -using the back of the wt�te cbpy'rf necessary - the work covered by this requ�t:
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NERAL FEES Outdoor Lighting Standard $1
SERVICES / POWER SU PLIES � Traftic Sianai Standard id �.5
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)MMUNICATION, REMOTE CONTROL,
CIRCUITS OF LESS THAN 50 VOLTS
ivstem Device or Anaaratus (6D $.50
Park
ALLATION MAY BE ORDERED
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20134151
Sup lemental Fee @ $20
Transformers u to 10 KVA ,$10
Transfartners wer 10 KVA a$ 20
Transformer / Power Su I for Si ns / OuUirre Li hti $5
ONE & Nd0 FAMILY DWELLINGS, EACH UNR
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two InspecGon Trips Each Dwelimg Unit @$80
Addfional Ins ection Tri s a$20
Irnesti� ative F�
Reins ection Fee a $20
TOTALFEE
(minimum total fee is $20) � � (�
I hereby certlfy that I inspeded the ele�lcal insfallatlon described herein on the dates stet�:
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Fwums�cnwv -r GP t`3-7 -d �r�
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ECTED IF NOT COMPLETED WITHIN 12 MONTHS
FOR �'§ Fk'.� USE OF,'LY '
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� ��/� - Q Rough-in Inspectlon Required7 �Y� ❑(do Inspecdon Other Than Rough-In: 0 Ready Now f�Vill Call I
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c.�o You must call the inspector when readyi Date Ready:
I certify that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby �equest inspection of the electrical work at
Job Site Addrass �hy
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�se Number Mader Electridan or Power Umited Tech
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Iea�� Provide Two 2) Phorre Numbers Induding Area Ca
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ELECTRICAL INSPECTIONS PERMiT No. = '} �" � �°� °' -��
CORRECTION ORDER . �aTe �i � -' ~ r=-° �
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Installer of Wfring� '- -
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The following items are deviations from the accepted standards of construcUon at the above described
premises. Numbers after each ftem are applicable NaUonal Electdcal Code Sectlons:
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Correct the noted deflclencies and:
O NoUty Inspector for relnspectlon betore covering wiring.
O�Re-Inspection will be made at time of next Inapectlon.
❑ Sign end return thla form to Inspector when correctlona have been mede but no later
then (Date:)
Signature of Instalter
Robert Clauson
1586 E. Sextant Ave. Date of Compliance
Maplewood, MN 55109
Call 651-777-7885 for Reinspectlon - 7:00 - 8:30 a.m.
Monday - Friday except holldays.
RC-01