P - 76018REQUEST FOR ELECTRICAL INSP'�CTIOI� ��' �
1�� 2 0° 4, �� � Minnesota Board of Electricity
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us
Desaibe -using the back oi�the white copy 'rf necessary - the avork covered by this request: 'W.�— 5 +� Y!
�C V 4G.JL � � � W� i11av.S�
. ..�.��o.� «« ,....�___ � ._�..__ ... _�_� � T.
401 to 800 AmPere @ $ �0 — �
Above 800 AmPere @ $75
,UITS / FEEDERS
0 W 200 Am ere �
Above 200 Am �ere a 0
tM, COMMUNICATION, REMOTE COIdTROL
,UITS, CIRCUITS OF LESS THAN 5D VOLTS
Each SYstem bsvice or APP�� @$.50
ADDRIONS TO THE GENERAL I
fIFAMILY DWELLINGS (PER UNI11
3 to 12 Units (6D $50 Per Unit
Traffic Sianal Standarc!
� ONE & 1W0 FAMILY DWEWNGS, EACH UNIT
Includes the Service and/or Powar Supply up to 500 Amperes, All
• Circuits and Two Inspection Trips Each Dwelling Unit @$BO
Addfional Insas.fion Trios C�D $20
total fee is
��s�
;etrofit �$.Z5 t FOdure I heteby certl(y that I h�peded tlre eleclrical h�afa d�d herein on tlm dates �:
rot I ation Boom @ $40 '�'�" "' �^�
ired Home Park Lots $25 � �""�-�
nal Vehicle Park Sit�s $5 �'-01�Q"0N �y. �T���
Bon I 'on $20 d T
s n (d� $30 r Hour °��"�01'¢D �^�
s on @ $.31 r MGe
ALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
FQP. �FFIC't IiSE 6NL1'
� ��� I� I� � �� �I III �� n� �� I�I �� �� 8 �0 �� ��i
18204594 �Q��(}���1L�
�' '� j� � Rough-in Inspection R�uir�7 Yes ❑ No Inspecdon Other Than Rough-In: ❑ Ready Now ❑ WIO Call
You must ceil the inspector when readyl Date Ready.
I certify that I am the 0 LICENSED CONTRACTOR ❑ COMPANY �OWNER and hereby request inspection of the electrical work at
Jo�\ l' �6 Vl G"S'�\\ � 9 ii.S �� \�1� C� �\ C�i\ �. Ls
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Electricel UtUity • ' pectrjcal UtAity Address
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ntredor! Company N i��' �
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Mallina Addr�s (Con w. Comoanv or Owner PerFortnina Ir�sfallatlonl
Please Provide Txro (2) Phone Numbeis .
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1s S
M or Power Lin
License Num6er
PJeAse Provide Two (2) Phone Numbers I
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