P - 76277� EtEQUEST FOR ELECTRICAL INSPECTION
1����- 5 3 3� Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
.,�, __�''� ' , (651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
Describe -using the back of the white copy if necessary - the work covered by this request:
C�t;Ci_ EhlE�iGY SAt�E�;'S SWIT�'H
GENERAL FEES Outdoor Lighting Standard @$1
SERVICES / POWER SUPPLIES Traffic Siqnal Standard (� $5
CIRCUITS OF LESS THAN 50 VOLTS
TO THE GENERAL FEES
ONE 6 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up ro 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unft @$80
total fee is $20) � ��_ �'�
the electri�l insfelletion describ� he�ein on the detes stated:
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MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
RECD J U N 14 2001
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�� Rough-in Inspection Requlred7 ❑Yes �]No InspecUon OtherThan Rough-In: [�Ready Now ❑WIII Cell
�� �. �. f�J � You must call the inspector when ready! Date Ready:
I certiFy that I am the �1 LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
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Township Sectlon Range Fire No. Courhy`
OWner/QpcupaM Name Please Provide Two (2) Phone Numbers Including Area Cade
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Elec6lql Utitity Electrical Utility Address
�CEL ENERG'�
ContraCtpr / Company Nama Conhactor License Number Master Electrician or Powrer Limited Technician
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MaUNig Adriress (Contractor, Company or Owner Performing Installation)
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q�rthorbsd SlgnaUire (Contractor or Owner Pertorming Installation) Please Provide Two (2) Phone Numbers Including Area Code
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