Loading...
P - 75523�` ^ REQUEST FOR ELECTRICAL INSPECTION y��` 1 � ��"r � � � 41 � � Minnesota Board of Electricity 5 , ` 1821 University Avenue Suite S-128, Saint Paul, Minn�ota 55104 r (651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us Descdbe -us " back of the whfte copy'rf nec�ssary ' vrork avered by this rec�{est: Standard CIR S/ FEEDERS " Transfortner I Poa�rer Su 1 for S' r�s / Outline Li $5 0 W 200 Am re$5 ONE 8 TVNO FAMILY DWELLINGS, EACH UNR Above 200 Am re $10 Includes the Service andlor Power Supply up to 500 Amperes, All AIARM, COMMUNICATION, REMOTE CONTROL, SIGNALIN Cira�ts artd Two Irrcpectlon Trips Each Dwellmg Unit @$80 CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS AddiUonal InsoecUon Trios C�a. $20 3 ro 12 units @$50 Per Und (minimum total fee is $20) Each Addrfiomal Unlf (oj $25 '�^"E"`��f0R0 ��� OTHERADDITIONALFEES M�/• �G—d a—' UpMing Retrofit C�D $.25 per Fature I herebvi certifylhat I Inspeded ihe electriml insmlia8on p, (7 d � •S"?� ATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS � F'JP, t7FFICE USE t7NLY I�IIUI�IUIIIII��IIIII�IIIIIIIIIU��I� , s a� 18204156 �a�� '����� /��'�(� �� Rough-in Inspedion R uired? �es ❑ No I /��� � nspectlon Other Than Rough-In: 0 Ready Now �WiO Cell IYou must call the inspector when ready! Date Ready. I certliy that I am the ❑ LICEWSED CONTRACTOR ❑ COMPANI' � OWNER and hereby request inspection of the electrical work at Job Site Street Addresg Cttv i � � �6 I Contractor / or ��� �l —R 33�d' (fc6 f ) 32�'�-iSf V - � M�ter Electrician or Power Limfted Techr Licanse Number le Two (2) Phorre Numbera Indud(ng Area Cod� t-�3� � (c�U3Z�—�{SZ ca_m�nn�n �s v .