P - 76263• REQUEST FOR ELECTRICAL INSPECTION
I �� 7 9 7_ 5 4 g� Minnesota Board of Electricity _' ;
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
�- ""' ' , (651) 642-0800 TTY/MRS 1-800-627-3529 www.edectricity.state.mn.us
Describe -using the back of the white copy if necessary - the work covered by this request:
F:�CEL EhlEF;GY SAVEF:'S SI�ITCH
GENERAL FEES Outdoor Lighting Standard @$1
SFRVICES / POUVER SUPPLIES Tra�ic Signal Standard na. $5
IITS, CIRCUITS OF LESS THAN 50 VOLTS
aCh System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL FEES
FAMILY DWELLINGS (PER UNin
to 12 Units @$50 Per Unit
'ALLATION MA'
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- II
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�;7975497,
Transformer I Power Su I� for Si ns / Outline Liqhtlnc a$5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Suppiy up to 500 Amper�, All
Circuits and Two Inspection Trips Each Dvrelling Unit @$80
Addi�onal Ins ction Tri $20
Invesbgative Fee
Reins 'on Fee @ $20
TOTAL FEE
(minimum total fee is $201 L�= 5�
I hereby certiTy that I inspected Ne electrical instaVation described herein on the da0es s�ed: �
IF NOT COMPLETED
REC°C� ., � �� 14 2001
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°1�' Rough-in Inspection Requiredl ❑Yes � No I�spection Other Than Rough-In: [�Ready Now �WiO Call
�f� �. �. +OQ% You must call the inspecror when reatlyl Date Ready:
I c�rtify that I am the C,cl LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical wark at
JobSkeStreetAddress ��FRZ�LEfq I��I
5575 W DAPdUI�E Fiii •
�nvccupam rvame Please Provide Two (2) Phone Numbers I
F�GI�IAhf OLSOhag CFI�IS i ihlE S ( ) ( )
Elec�Cal UtNity Electripl UtilityAddress
�CEL EI�Ef:G �
Cant�dnr / Company Name Contrector License Number Master Electrician or P�
HUi'd7 ELECTFiIC Ct�F;F'llFiP3�TC�h! �� �jQ$$�, ucenseNumber
ApaiBrtg Address (Contractor, Company or Owner Performing Installation)
�3t7t? TERF;ITC►�I�L F:GAD9 SA2hli f-'�iULq �ih! 551:L4
AuthOrized Signature (ConVactor or Owner Pertortning Installation) Please Provide Two (2) Phone Numbers I
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WS�iUCTION9 ON BACK OF YELLOW COPY BOARD OF ELECTRIGTY COPV
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