P - 78371REQUEST FOR ELECTRICAL INSPECTION
1� 4 6 3� p V U � Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us
C�NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy 'rf necessary - the work covered by this request:
nec auto labeler-Add 600 A FDR UPS
GENERAL FEES Outdoor Li htin Standard $1
SERVICES I POWER SUPPLIES Traffic Sianal Standard iv S5 w ,�'ia
ALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aooaratus � 5.50
Per Unit
800111
ONE 8 TWO FAMIIY DWELLINGS, EACH UNIT
Includes ihe Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$60
Fee
(minimum total fee is $20) � 1 12 . 5 0
THIS FREA FOR kSPECTpi USE ONLY
I hereby certify Mat I inspected the electrical instap�on described herein on the dates sfa0ed:
- - � , -
S iallns 'on E.31 Mile
�HIS INSTALLATION MAY BE ORDERED DI3CONNECTED IF NO
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rcequesc ua�e: Roughin Inspedion Required? ❑ Y� C�NO Inspeclion Other Th� RougMn: �Ready Now VUtl Call
9/ 2/ 0 3 You must call the i�specla wh� reedy! Date Ready:
I certify Uiat I am the C�ICENSED CONTRACTOR ❑ CONNPANY ❑ OWNER and hereby reqt�est inspection af the electrical wak at:
ma��c���wns�vw uwcR aF 1ELLqY COP► BOARD OF ELEC7RICITV CAPV E&00001M74 8.1.2002