P - 76264• EtEQUEST FOR ELECTRICAL INSPECTION
1� 7 Q����!Q Q� Minnesota Board of Electricity
�� °r v 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
' , �651) 64,2-0800 TTY/MRS 1-800-627-3529 www.electricity.state.ryrn.us
L esGribe -using the back of the whfte copy'rf necessary - the work covered by this request:
C�CEL EI�EF�GY �AI+�F: `8 S�9ITCH
GENERAL FEES Outdoor Liqhtinq Standard na. $1
OMMUNICATION, REMOTE CONTROL,
, CIRCUITS OF LESS THAN 50 VOLTS
5ystem Device or Apparatus @ $.50
ADDITIONS TO THE GENERAL F
MLY ONIELLINGS (PER UNIn
2 Units @ $50 Per Unit
Additional Unit @ $25
OTHER ADDITIONAL PEES
nq Retroflt Ca) $.25 per Fixture
Transfortners u to 10 KVA $10
Transformers over 10 KVA @$ 20
Transformer / Power Supply for Signs / Outline Lightlng @$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$BO
Fee
total fee is $20) � "� c�
that I inspected the electrical Installatlon descrlbed herein on the dates stated:
Speeisl Ins ction @$30 r Hour °��D1"BPN0�1E0—`-
5peciat Inspsction � $.31 per Mile
�i WSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHII
IIlf �I��181111111I�IIIII�IIII181111111�� �C�� �JN 14 200�
1 7 9 7 5 4 8 3 ���� ^����
�' Rough-In Inspection Required7 ❑Yes �] No Inspection Other Than Rough-In: �Ready Now ❑Will Call
�'� ����� f You must qll the inspector when readyl Date Ready:
I certdy that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
.io� sne sveet a,ddress �� F Fi I D L E`i q irl hl
So�7 i�4 I)r^ih1U1�E F;D
.�,,
Township Section Range Fire No. Courlty` '
��r�-i�sor�4 sus�r� � ( ) ( )
Eledripl Utiliry Electrical Utility Address
�CEL EE�E�G f
Contradpr / Cpmpany Name Contractor License Number Master Electricfan or Power Limited T�hni
Hllh-!�" ELEGTF:Z� � QRF'OE:A I ICli;l CA t7t)s.i$,:� LlcenseNumber
MaN{ng Address (COntiactor, Company or Owner PerForming InstallaHon)
�.��2t7 TEnFiITCiF:T�L f;OADq :��,ThIT F'AULq I�i�l 5�11�
Authorbxd Signeture (Contractor or Owner Perfortning Installation) Please Provide Two (2) Phone Numbers Including Area Code
(��:� ��a�-�s�� i )
INRTRIIt:TIt)NS nN S(:N (1F VFI 1!1W rl1PV aneon n� c�� cnTOir�rv nnov ' �-n ........,. .� ...