P - 75404� REQUEST FOR ELECTRICAL INSPECTION � °;
��������� � 827 Unrvt rs�Aen e Surte S-�8, Saint Paul, Minnesota 55104
(651) 642-0800 TfY/MRS 9-800-627-3529 www.elech^icity.state.tnn.us
�Descnbe -usim,� the �dc ot the white co y'rf necessary - The work covered by this request: ��O�S� 4��f � Q r' C�
_ �/�^s,eH•en.'� '�+rt �s� — II�Av�q� 1 �'l no. c� Fr rM•.� �
)MMUNICATION, REMOTE CONTROL,
CIRCUITS OF LESS THAN 50 VOLTS
iYStem DeviCe or Apparatus C�a. $.50
INSTALLATION
Ill�lll��l�llilfl��l�l�lllll��l��l� -
18202903
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over
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each DwelGng Unit @$60
spec�on Fee (a� $20
TOTAI
(minimum total fee is
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rtuytnat i �md ure e�
wN
vmo�n _ ,
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IF NOT COMPLETE
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desaibed herein on the da�s ateted:
FOR OPFlCE USE 4NLY
REC'D JUN - 7 2007
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Rough-in Inspedion R�uired? ❑ Y� ❑ No I�pecllon Other Than Rough-In: � Ready Plow � Witl Cell
You must mll the inspector when readyl Date Ready.
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I certify that I am the ❑ LICENSm CONTRACTOR ❑ COMPANY � OWNER and hereby request inspe�on of the electrical work at