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P - 78209REQUEST FOR ELECTRICAL INSPECTION 1� J��- 515 4❑ Minnesota Board of ElecUicity - ^ 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 (651) 642-0800 TTY/MRS 1-800�27-3529 www.electriciry.state.mn.us ❑ NEW EMOD L❑ ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the work covered by this request: �1r�fi-�cw(, �,- ba,se,w,�-�rush, ��cl��ate, er�cf�`c �u..�et, l�F/C�gr.-��c. ALARM, COMMUNICATION, REMOTE CONTROL, CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Each System Device or Apparatus @$.50 ADDITIONS TO THE �ENERAL F MULTIFAMILY DWELLINGS PER UNIT 3 to 12 Units @$50 Per Unit ' � Each Additional Unit @ $25 ' Center Pivot � THIS INSTALLATION MAY BE ORI IIII�IIIIIIIIIIIIIIIIIIIIIIIIIIIII�II�II�I� 15305154 i iainc �i nai atanoara yo t� .—� Su lemental Fee $20 Transformers u to 10 KVA $10 Transformers over 10 KVA $ 20 Transiortner / Power Su I for Si ns / OuUine Li htin $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 Unil @$80 Additional Ins fion Tri $20 Investi ative Fee Reins tion Fee $20 TOTAL FEE (minimum total fee is $20) �7� iNIS AREA FIXi INSPECiOR 115E Wlv I hereby certiry that I inspected the electrical installation described herein on the dates stated: IF 12 ��-^" � � .� 3� � �� � � `�` I Request Dffie: � Rough�n Inspection Required? � Yes ❑ No Inspection Other Than Rough-In: �Ready Now �1 Will Call � �^��- � y You must call the inspector when ready! Date Ready: I certify that I am the �I.LICENSED CONTRP�� ANY ❑ OWNER and hereby request inspection of the electrical work at:: Job Site Address (Street Box, or Route"�.), Ci�� .. Zip Code�y�� �� �T'i�'ls�rl 1/�V� �� `�'I� �!��'7,=�"1 Sedion Township�� Ra� � Fire No. CountM � H� Owner/Ocw nt Name Please Provide Two (2) Phone Number(s) Induding Area Code ,i�',U"°1�/� ��/1,s'OY� �lt�-s��"�1�:,� ) 7,�-(.(�� or Owner Pei �� �� ��"�� � Address Ls �-�-f L� � ��� �o ConVactor License Number Master EJecVician or P � . n ��7 -� / ! License Number {'`C+ '--'�1 eo�o oF e�crnicm coar J /� EB-OOOOtA-14 8.1.2002