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P - 759311-89�-459� �fscn'be -usir�g the b k of the w�it� copy H n� 6�'I ff GENERALF S 401 to Afmve CIRCURS OF LESS THAN 50 VOLTS iystem Device or Apparatus @ $.50 ADDffIONS TO THE GENERAL I Manufa�ued Home Park Lots REQUEST FOR ELECTRICAL INSPECTION Minnesota Board of Electricity ' 1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104 (651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.sdate.mra.us - the work covered by this r�uest: �l EL Outdoor Liahtirm Standarcl Ca� $1 I THIS INSTALLATION MAY BE ORDERED II�I �I IU II Ill II I�I II I�I � IU II III U��� I� 189�4591 Tiansformers over 10 KVA $ 20 Transfortner / Powrer Supply for Signs / Outline Lighting @$5 ONE 8 TWO FAMILY DYdELLINGS, EACH UNIT Includes the Service and/or Power Supply up to 500 Am�res, All Circuits and Two Inspection Trips Each Dvreuing Unit @$80 total fee is I hereby cerdfy thet I inspeded fhe electrical U�sfeVatlon d�cnbed herefn on fha dat� �ated: �� �2,._ �-�-.� riwu msawnav �+ nare � ���%� �� FuR OFPiCF U5"t ONLY � �>�' -� �� � �D�V � l ( 7�C I��� �� Rough-in Inspedion Required7 �Yes ❑ No I�p�tion Other Than Rough-In: 0 Ready Now �IVpI Ce0 I� / You must call the tnspector when readyl Date Ready: I certi(y that I am the LICENSED CONTRACTOI� ❑ COMPANY ❑ OWNER and hereby request inspection of the elechical wark at Job Site Street Add C,� n'� y,�' / � /�7 � �� 7 � �'�� �i�� � V �G' � � / � � cense Numner master eie�xndan or ��� License Number �