P - 76160REQUEST FOR ELECTRICAL INSPECTION
— 7 4 4� 5 0 7� ;"�; ��A e�es� �8, �� �w� Minn�ofa 55104
����� (851) 642-0800 TTYlMRS 1-800-627-3529 www.electricity.state.mnus
ALARM, COMMUNICRTION, REMOTE CONTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Eech Svstem Device or Aooaratus (�o 5.50
3 to 12
Tratfx Sianal Shandard
'. �' ONE & TWO FAMILY DWEWNGS, EACH UNR
�I�ludes the Service and/or Pmver Suppiy up to 500 Amperes, AO
Cirr.uits and Two Ins�Ction Trips Each Darelling Unit @$80
TOTAL FEE I �� .
(minimum total fee is $20) �� F
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I hmeby c�6fy ihet I Inspected Um �ectrical i�0adon des�ed I�in on flre dales sta0ed
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ne4�� �� R�gh-m Inspectlon Required4 LJ Yes � No Uspecdon Other Than Rough-In: ❑Ready Now� NNI Cail
Yau must cell the ins� when readyl p� �y,
I csrtlly tt�at I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER arui hereby request �upection of tlre e�ch�ical xrork at:
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