P - 76320� REQU�ST FOR ELECTRIC ��I�N� PECTION
I 1� 8 2�� 4� 5 � Min�esota Board of ElecVicity 5���/,%Z� —���5`'
1821 University Avenue Suite 5-128, nt �`uf�Gfinnesota 1
' , (651) 642-0800 TTY/MRS 1-800�27-35Z9 www.electricity.state.mn.
D�cribe -using the back af the whfte copy (f ne�ssary - the work covered by this �equ�t:
•1� . : :l�T�
� Transfomrer / Powrer Supply for Signs / Outlirls�Jfidng @$5
ONE 8 TWO FAMILY DWELLINGS, EACH UNR
Includes the Service and/or Power Suppty up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
CIRCUITS OF LESS THAN 50 VOLTS
MULTIFAMILY DWELLINGS
total fee is $20) � t�/.
!t/o• c el /
/'�[a f NO%J►
I herebvi cerdfv thet I Nscected the electrical InsteVadan d�d herein on fhe dat� at�ed:
i Home Par1c Lots f
Vehicle Park Sites
..r...,���.�a,�.,..�� ,...�.,,,, �.%
Speael Insp�tion @$.31 per Mile '� `�'°"� �! /� QG
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WfTHIN 12 MONTHS
FOF OFFlCE USE ONLY
IIIIIQ�I�I��ililil��I�11111�1110�1�
18204859
��� n Rough-in Inspectlon Raqulred9 ❑ Yes No Inspectlon Other Than Rough-In: ❑ Ready Now WIO Ce0
��/` (/�' You must cell the inspector when readyl Date Ready.
I cefify that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY �bWNER arM hereby request inspection of the electrical work at