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P - 75451REQUEST FOR ELECTRICAL INSPECTION r� 1��� o� 4 4 5� Minnesota Board of Electricity ( - . 1821 University Avenue Suke S-128, Saint Paul, Minnesota 55104 (651)642-0800TTY/MRS 1-800-627-3529 www.electricity.stoJe.mn. D�cri� -usi th back of the white copy'rf ne�sary - the work cover� by this request: N�w�3� �.:t ��euc?� 1� 2 ��llP�MS � I CIRCUITS / FEEDERS IMMUNICATION, REMOTE CONTROL, SIGNALING CIRCUITS OF LESS THAN 50 VOLTS 3 W 72 Unfts @$50 Per Each Addfional Unit @ 9 15.�� Indude.a the Service andlor Power Supply up to 500 Amperes, AO Circuits and Turo Ins�ction Trips Each Dwellmg Unft @$80 TOTALFEE total fee is $20) � . - I hereby certHy that I U�speGed the electricel iristalllatlon desrn'bed h�efk o-^� i� sta �a,w � �v---- �� 2 - d � �ectlon @ $30 r Hour �K� ��q'`"�� �O , �j ( �O �ectlon $.31 per Mile ,� � eTION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 S FOR OFFICE USE ONLY I IIII lilll II�I IIII� IIIII IIIII IIIII ��I �� Il�f ����.� � 18204453 �� ��� �� Rough-in Inap�tion Requfred7 �Yes ❑Ido Inspe�tion Ofher Roug In: ❑ Ready Now ❑Wm CaII �6 31 You must call the inapector when readyl Date Ready: '� a` Q I certify that I am the ❑ LICENSED CONTRACTOR ❑ COMPAWY WNER ami hereby request inspection of the el�trical work at Job Site Street Addresa City �(540 h`.�� il�/�( N� �D��( � ��L ntrador / Comoanv Name W �UF-�"� oanv or Ormer F I��� 'rovide Taro (2) Phorte Number 5� �O �Z (°ilo3 � iber Meater ElecVidan or Llcenae Number g Area Code - 5��2 �cludirtg Area � 1�� ca_nmmi�e �a