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P - 75395° MUnn�ota t?�P�� of Labor artd iridusdy 443 Lafayette Ro�d l�tMh SL Pst�l. M1V 1�5-4342 • Phone: (8b1) 5�4 TtY/�AR5: ( ) Z97-4198 u�vw.efer.tri .state.rrtn.us Con tnr R uesi for Electr�c�l Ins ec�on — Ane Farr�il. �nrelit� lAs�ociated �ature � Rough-1� lns�lon R�quir+ed? Y� �� Tdan Rough-la: !�y Noav /� �s � Conbac�or IVlust �c�edule AA i �o� Must'Srhedt� All Finai V�H Sd►edu� Adtires.a of fnspedion — Sb�eet CiiylTa�+nsftip Cour�y •�_3j /�i.ss:ss �� -s, �u. �. �.e, o�.�� ,�.vo�c,g- Oamer Pleme Praj�c� D�cn ,�itRk i �� P€ /�.�'l�f�@�n /P�.na �G L t?umer %iephone Ks) — hulude Are� C�e(s) ' - a- 867- /S` `7 �A-v� a c.�ec�r iTs Gc�r+tractor Name cor�acror nn�3ttng Addre� -:=Y C� ��G ��€��,e,� �►c ��.�7 a�9T� �v� �✓� �c� iP��,�.e, .�1.� �"�.3�v �or�trador Telephone Numl3er �adop E-�„�a na�� ;�, �l�— d''6�- D�O& .L G G� ✓v.�9G � �L . C��„ ��.9. Cor�at�or AutharFaed nabu�e Contrador Lir,ense Nurr�ber Job/Project Contad P�n � ,� C�i o � i� � �o�� 02,� - lo /a - o?8a? - 7 !�'16 - � F�e Caiculativn htewr Hame o� Associated Structtur� E�Isting ilame/Structure i�model ar Additbn New �roeUtng Senrir.e/Power Supply 0— 40� ampere � 535 New �rvic�Pov�r S�tPR�Y 0—'►00 ampere (� $38 . Neuv Dwalling Servise/Powar �ly 491— 800 ampsre (� S80 New Seroi�t�rrer Suppfy 401— SQO amPere � $60 Nemr Dwel�rttj Feedera/C[ncuffs - - Ne�n+ �e�ets/6� — tfP bo 15 F�hpiite -- � U tv 30 F ' - S700 � Feeda�s/Clrar� $8 Eer.h cr 18 to 30 9� Ideat Home — AAore than 30 Feed�rs/Cltcuib (In adtlitlon to Nauv F�erslCireuas _ aer,r., rr,s� an e�.�rr�..,..a.: Det�ched C�age or Other Assaciafed Struc�tre �,► serv�rPower sur��r a-- �ao am�re � s� Neta FaedetefGircu� ( ) (a� g@ E� D�ached Ga�age or Otiier As��iate� Strsuctur� New servioel�o�rer sup�ly o — � �e � � Nebu F�IeralCiraiits. ( ) � � � Reconne�te�! Feeders/Ciecu� ( ) � $2 Eaah TO#al (the tee c�elaifated above vr $36 r►wwkipfied To�l (thetee �la,t� � or S35 mu�pU� 7�.+� o bYarhi�c�Aretur� rr�ra jak� �ns�c�n {rips, whichever is �� Rection trips, s u ac� �� s'� �� Req� ror El�i lna�bton (REij �ertU, a tea af s'2� or tass e�ire 12 n�a� tc�n the the 12 montlt period or sabmtt anodter f�l 8ret �ctt�s the Ins�an F� tor trie � date. Ths �"aator mu� I�ve tlte work catriple�d vrffhln w�eomPTeted work. t�oa T�.s do nat eany ov� irwn are REI to artcther A servloe Charge of ��) l� add�i tar eff dlshonored cit�lte. f heteeY c�r� that 1 h� the el�rft�l &tsl8ltaHan ttete&I � the datea st�sd: � p�� Rough — In Inspedion(s� : - • Da�e �.. '��"�r_.__ /�'�! t'� Flnal an --- pate �C� �' �' T�- n 2008 �-�-� �� -� �,��,��,��.�,��g��s��.�o �I� TDD (8S9) �7-41�. �4�, eall 1-�11-38Z�354 (QiN,-DLn Vo� w RE102 (�10�