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P - 76131REQUEST FOR ELECTRICAL INSPECTION � �`, ��� 2 0� 4 7 2 � 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.stote.mn.us Describe -using the back afy� �w�h�it�e co if necessary - the work covered by this request: fTc' E d 2 P�C U 6/ /i-N,� $W� r�uES Fo�e 7�1�- C�l�c �n/6 Ff}N GENERAL FEES Outdoor Lightin Standard $7 SERVICES / POWER SUPPLIES Traffic Signal Standard @$5 ��� _ .URS, CIRCUITS OF LESS THAN 50 VOLTS Each System Device or Apparatus @$.50 ADDITIONS TO THE GENERAL FEES � Center Pivot IrtlaaUon Boom LATION MAY BE ORDERED D I��QI��I�i��II�III11��I01�0�I� 182�4727 ONE & TWO FAMILY DWEWNGS, EACH UNIT Includes the Service and/or Power Supply up to 5U0 Amperes, All Cin;uifs and Two Inspacbon Trips Each Dwelling Unit @$80 total fee is $201 I 7/. I�ed the electrical hslaVatlon desamed herein an the dates s�ed: � �� �,/� �o � — �-'6 IF ��� Foka�rir_e � aN�Y� ., %j�) �, � ��� Rough-in I�repection Required9 ❑ Yes ❑ No InspecUon Other Than Rough-In: 0 Ready Now O W�11 CaA You muat call tha inspedor when ready! Date Ready: I certify that I am the � LICENSED CONTRACTOR ❑ COMPANY �(J OWNER and hereby request inspection of the el�trical work at Job Site Street Address City `%�glD �'1'//YSent 1'�L�� �'�P/ntFf� /Y%/c. oMract/a^r or GP. � I �4/�lB Kta- Please Provide Two (2) Phone Idumbers Im ��3) �8y 38v� ( ) Master Elechician or Pawer License Number '38f�� ( )