P - 78156.
1-576°113 0
❑ NEW ❑ REMODEL ❑
FEES
i800
� 800
/FEE
ALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aooaratus � 5.50 _
$50 Per Unil
Unit � E25
Sites ;
°n �
cer Hour
REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electriaty
1821 University Avenue Suite S-128, Saint PaW, Min�sota 55104
(651) 642-OB00 TTY/MRS 1-800�27-3529 www.electricity.state.mn.us
� Descri - ing the back of the white copy 'rf necessary - the work by ihis request:
r C� �►ti►� /�-�iZ. C1.c?N�.�.
Outdoor L' htin Standard 51
Traffic Si�nal Standard � SS
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Senice andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �1$80
TOTAL FEE 5`O
(minimum total fee is $20) � -�-
THIS AREA FOR INSPECTdi USE OKY
I hereby cer6ry Mat I inspected the electrical install�on desuibed herein on the dales stated:
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15761133 �
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ReQuest Date: Roughin Inspection Required? ❑ Yes Inspedion Other Than RougMn: �Ready Now WNI Call
�—� �—� � You must call the inspector wlien ready! pete Read�,
I certify lhat I am the ❑ LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection oi the eiedrica� work at:
�__._ �._�......r . w'nw ur eLCC:I KICITY COPY E&00001M11 8.7. 2002