P - 76293• I�EQU�ST FOR ELECTRICAL INSPECTION
1�� J�- 5 31 � Minnesota Board of Electricity • i
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
__ __ r ' ,(651) 643-0800 TTY/MRS 1-800-627-3529 www.edectricity.state.mn.us
Describe -using the back of the white copy'rf necessary - the work covered by this request:
E�CEL EhIEF;uY S(��1E�°S ��lTTi H
GENERAL FEES Outdoor Liahtina Sfandard an �1
/ POWER
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL FEES
to 72 Units @$50 Per Unit
MAY BE ORDERED
1 I!�I II I� � I� � I� II �I II I� II III II HI I�ll1 I II�
1'�975319
Traffic Siqnal Standard
� Transformer I Power Supply for Signs / Outline Li htin $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circufts and Two Inspec8on Trips Each Dwrelling Untt @$BO
Additional Inspection Trips @ $20
InvestiaaNre Fee
TOTALFEE
total fee is $201 ��_ ��
I hereby certiry thet I inspected the electrical installaation described herein on Ne dates
_IF NOT COMPLETED WITHIN 12 MONTHS
REC'D J U N 14 2001--
�Q��-���,�
uace: Rough-in Inspec6on Required7 ❑Yes �]No Inspection OlherThan Rough-In: [�Ready Now ❑WIII Call
� I�. �. ��? You must call the inspector when readyl Date Ready:
I r.eitiiy that I am the �I LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
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�,wrrc�u�ccupanc rvame Please Provide Two (2) Phone Numbers I
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Electrieal Utility Electripl Utility Address
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ConVador / Cornpany Name Contractor License Number Masffir Electrician or P�
H1Jh%T ELECTRIG C�JF;F'OFi�iTI0i�1 G�1 Uf?EiB,i �censeNumber
Ma�71ng Addtess (Contractor, Company or Owner Performing Installation)
�3�]te TEFi�iTTQf�Ti�L �OAU9 SAI1�lT F'�1LIL, �ii�f 55114
AIRholf�ed $Ignature (ConVactor or Owner Performing Installatlon) Please Provide Two (2) Phone Numbers I
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