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P - 76703REQUEST FOR ELECTRICAL INSPECTI��. ��� 2�� 2 6 g� Minnesota Board of Electricity 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 (651)642-0800TTY/MRS 1-800-627-3529 www.electricity.state.mn.us e ribe -using the back of the white copy if necessary - the work vered by this request: 4�1�S�.r� �.vT V`��r� c��� L �Oo 2� /v�;�� � s/��-rr�: ;�1/ GENERAL FEES Outdoor Lighting Standard @$1 SERVICES I POWER SUPPLIES Tra�c S' nal Standard $5 0 to 400 Ampere @$25 Su lemental Fee $20 401 to 800 Am re $50 Transformers u to 10 KVA $10 Above 800 Amoere Cc� $75 Transformers over 10 KVA (�a $ 20 UITS, CIRCUITS OF LESS THAN 50 VOLTS Each System Device or Apparatus @$.50 ADDITIONS TO THE GENERAL FEES Center Pivot Irrigation Boom @ Manufactured Home Park Lots Includes the Service andlor Power Supply up to 500 Amperes, All Circuits and Two Inspection Trips Each Dwelling Unit @$80 Additional Inspection Trips @ $20 � investigative Fee Reinsqection Fee na, $20 ��' v I herebvi certiN that I TOTAL FEE � �—�j total fee is $20) THISAREAFORWSPECTORUSEONLY f . � � f.! � �1 i the elecmcai instananon aescrioc� ��,.,,.... _ DATE ii� � ` `� � OnTE � �L. Z �, —�% � THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS (��� �� ��� �� ��I II II� (� ��� �I I�� �� f�) �� ��� �� �� 1820269? �---� ---{��� ����c�`� Date: Rough-in Inspection Required? ❑Yes ❑No Inspection OtherTha ough-In: ❑ Ready Now ❑Will Call r �;� "' :��? (,S � You must cail the inspector when ready! Date Ready: I certify that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY �OWNER and hereby request inspection of the electrical work at: Job SRe Street Address City �c -� c; ��7 i rv :S c� f3�v �� ;�2i �� �� Township Section Range Fire No. County ,, ) �v � K� Owner/Occupant Name Please Provide Two (2) Phone Numbers Induding Area Code �►�C,�/ i�!-����%� t-) (%lp3�S?�2 3?�� ��C�;��s� i ��c.S Electripl Utility ElecUical UtiIRyAddress -- _ w n. � �;� j C;?cv.�lC+ � Address (Contractor. Comoanv or Owner Perfoi or I INSTRUCTIONS ON BACK OF YELLOW COPY Contrador License Number I Master ElecUidan or License Number illation) Please Provitle Two (2) Phone Numbers Including Area Code � � � � BOARD OF ELECTRICITY COPY E8-00007A-15 e i�nn� �