P - 76024REQUEST FOR ELECTRICAL INSPECTION ��
1- 8 9 5- 3 4 9�7 Minnesota Board of Electricity
1821 University Avenue Suite S-12S, Saint Paul, Minnesota 55104
I (651) 642-0SOOTTY/MRS 1-500-627-3529 www.edectrlcity.stade.mn.us
� Descn'� -using the �c of the white copy'rf necessary - the work covered by this request:
� e��r- � �Jo�r� o� `
GENERAL FEES Outdoor Lighting Standard @$1
SERVICES / POWER SUPPLIES Traffir. Sianal SYanrlard n�5
0 to 400
)MMUNIGATION, REMOTE CONTROI
CIRCUITS OF LESS THAN 50 VOLTS
iystem Device or Aonaratus f�D $.50
FEES
Mile
I I��I II I�I U �I lY (II II III II III II II) II II) �� I�
18953497
� Transformers rner 10 KVA @$ 20
_ J Transformer / Power Supply for Sigr�s / Outiine Li hd $5
ONE & TINO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, M
Circuits and Two Inspection Tdps Each Dwellirtg Unft @$80
total fee is
i
.�
inssm�auon d�cribed herein on the datea stafed: I
;CTED IF NOT COMPLETED WITHI
�oa c,�rr„�v us� i,rd�v
���1�51
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Rough-in Inspection Required? ❑ Yes [`]'I�o Inspection Other Than Rough-In: �eady Now � Witl Call I
���2 � You must call the inspector when readyl Date Ready.
I certify that I am the.xduCENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection ofthe electrical work at
Job Site Street Address C�
� /oj' Yers /��' C/2/Glle�
Address
1.7f[`J
( ) ( )
ise Number Master Electridan or P
,�, 9 p License Number
ntractor or Owner Performing Installadnn) Ple se Provide Two (2) Phone Numhers Including Area
> bb3).g60 �iYl� i )
YELLOW COPY BOARD OF ELECTRICT' COPV eo m�nn. n. �