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REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
1821 University Avenue Suite S-128, SaiM Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800�27-3529 www.electriciry.state.mn.us
� Describe -us' g the b e white copy if " essary - the work covered by this request:
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JMMUNIGAI IUN, REMOTE CONTROL, SIGNALING
CIRCUITS OF LESS THAN 50 VOLTS
E50 Per Unit
Unit � S25
L�1�
I II�I II III II III II I�I II ��I II III �III II III 0� I�.
16607137
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I oertify that I am the
INS7RUC110N8 ON BACK OF YELLOW
ONE 8 TWO FAMILY DWELUNGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
CircuiLc and Two Inspection Trips Exh Dwelling Unit @ E80
(minimum total fee is $20) � 0� v—
TMS MFA i0R INSPECTIXi USE ONLY
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You m�t caN the insPedor when ready! � Date R�d
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NSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the elecfical work at:
t9•00001M74 8A.2002