P - 77168REQUEST FOR ELECTRIC INSPECTION
� � � � � � g � � � Minnesota Board of Electricity ����(��yf� t ����
1821 University Avenue Suite S-128, Sain��aul, Minnesota 55'(b4 ;�'
C� �l„� (651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
Describe -using the back of the ite copy if necessary - the work covered by this request:
�a ' `7-7� - ��5
GENERAL FEES Outdoor Li htin Standard @$1
SERVICES / POWER SUPPLIES Traffic Sianal Standard Ccil $5
Above 800 Am ere a$75
CIRCUITS I FEEDERS
0 to 200 Am ere $5 i�h
Above 200 Am ere $10
ALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
3 to 12 Units @$50 Per Unit
Each Additional Unfl @ $25
OTHER AD
Liqhtinq ReVOfrt (�D $.25 perf
Transformers over 10 KVA $ 20
� Transformer I Power Supply for Signs I Outline Lighting @$5
NE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
(minimum total fee is
I hereby certify that I insDe�ed the electdcal installation desaibed herein on the dates stated: �
Special Ins ection $.31 r Mile
THIS INSTALLATION MAY BE ORDERED DISCONNE(
�IIIIIIIIIIIIillllllllllllllllllllllllll��I��
19299023
� , u _ � c _ . . _
� -.2d "'�' S- �
ua[e: Rou h-in Ins
I�_ �—� g pection Requiredl ❑ Yes Na Inspection Other Than Rough-In: ❑ Ready Now Will Call
You must cali the inspector when ready! Date Ready:
I certify that I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical woric at
Job Site Street Address City (
�•� n`-C ��� � G� i t 4,Y1 �CL� IV � �'f' � � 1 �Q..��
Please Provide Two (2) Phone Numbers Including Area
; ✓�a fil�5� l - lv� �f(� )
rical Util' Address
�
actor oense numcer titaster tiecmGan or
t �� �—'1/1/ LicenseNumber
\ / \ /
Area