P - 771871-�2��4�1 �
Describe -using the back of the white copy if nec
0 to 400 Ampere a$25
401 to 800 Am ere a$50
Above 800 Am ere $75
CIRCUITS I FEEDERS
0 to 200 Am re $5
Above 200 Am ere $10
ALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aooaratus na $.50
Unit
REQUEST FQR EL�„CTRICAL INSPECTION �`�
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Minnesota Board of Electricity �-: p,
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �'
(651)642-0800TTYIMRS 1-800-627-3529 www.electricity.state.mn.us �'"'"`
- the work cov red by this request:
��iC �i� ,�l i �r-fa �� hC c�'�
Outdoor Li hting Standard @ $1
Traffc Signal Standard $5
Sup lemental Fee @ $20
Transformers u to 10 KVA $10
Transformers over 10 KVA (�D $ 20
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
TOTAL FE j( i� f��
total fee is $20 � 7�%
Llghtin RetfOFR @$.25 p8f Fixtuf2 I hereby cerfify that I inspected the elecVical installation desaibed herein on ihe dates stated:
Center Pivot Irrigation Boom $40 RoucH�N on.e
Manufactured Home Park Lots $25 -� `� Cl �-'G
Recreational Vehicle Park Sites $5 F�Nn��NSV�cnoN on
Se arateBondin Ins tion $20 Z— d'�
Special Inspection $30 p2r Hour E%flREDlA64N on�
S ial Inspection $.31 r Mile
HIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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18204818
�a�� _� � Rough-in Inspection Required? [�'Fes ❑ No Ins
I pection Other Than Rough-In: ❑ Ready N � Will Call
� — O You must call the inspector when ready! Date Ready:
I certify that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY 0�80�NER and hereby request inspection of the electrical work at
Job Site S t Address , City
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Township �� Section Range � Fire No. Counry_ /�
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Owner/Occupant Na Please Provide Two (2) Phone Numbers Including Area Code
�'i l t �Gt�t 5 e r� (n� �8� �os�(las� ) 5�a s� 3�s�
ElecVical Utility ElecVical Ufility Address
C[.- /'Y1 l S lUt� ✓f�, �i v'1 `S i� U
C ntrador / Company Na�y�'jr� ConUactor License Number Master Electrician o ower Limited Technician
/ ! 1 � '�-.n n License Number
Mailing Address (Contractor, Company or Owner Performing Installation) •
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Auth ' ed Sigqature (Contre or o O er Performing Installation) Please Provide Two ( Phone Numbers Including Area Code
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INSTRU IONS ON 6ACK OF YELLOW COPY RnARf] nF FI F(:TRIf.ITV f:(lPY FR_nnnnlA_15 n 1 �nna
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ELECTRICAL INSPECTIONS PERMIT NO. ��` z �-� �('
CORRE�TION ORDER � �ATE ,! /- 2- - � s� ��--
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Installer of Wiring �rr �
OwnedOccupaM ,��/' /�� S P / � \ � r��ob �`G--�
, Property Address --� � U ~ �� /v {= S () � `( �L �; Zip
.;� jThe following items are daviatlons from the accepted standards of construction at the ebove describe.
, prer►�ises. Numbers atter each item are applicable National Electrical Code Sections: ,
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Cornct the notsd deflciencies and: ' " -� �'
O N�lnspector for reinapsctton beforo�covKing wiring.,
Q'�Re-inspsction wilt bs mads at tlme ofinsxt inspsct�i
0�81gn and rstum this torm tolnspsctor whsn corafctions have
than (Date:) �
Signature of Mateller
Robert Clauson
1586 E Sextant Ave agte a co���e��
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but no later
� Maplewood, MN 5510�J � � �-
��r Call 651- 885 for Re - 7: - 8:30 a.m.
� Monday - Friday except holfdays. '
RG-01 ':