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P - 77233REQUEST FOR ELECTRICAL INSPECTION 1� 7 3 6- 2 0 6� Minnesota Board of ElecUicity - 1821 University Avenue Suite S-128, Sairrt Paul, Minnesota 55104 (651) 642-0800 TTY/MRS 1-500-627-3529 www.e%ctricity.state.mn.us ❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR Describe -using ihe back of the white copy if necessary - the work covered by this request: S-Gt i cu .i .� C�' I�L--Fii e_ �6 h �n�cll -�' SERVICES I POWER SUPPLIES 0 to 400 Amcere � E25 CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Each Additional Unit � � I IIII II II! II III �� �I II III II lil II III �� I� 17362062 Traffic Si nal Standard S5 Su lemental Fee p $20 Transfortners u to 10 KVA $10 Transformers over 10 KVA � 20 Transformer I Power Su for Si ns I Outline Li htin $5 ONE & TWO FAMILY DWELLINGS, EACH UNIT Includes the 5ervice and/or Power Supply up to 500 Amperes, Ali Circuits and Two Inspection Trips Each Dwelling Unit @$80 Additional Inspection Trips @ S20 Inves6aative Fee tota� ree is s2o� I' .�(c � I hereby certify tl�at I inspected the electrical i�alla6on described herein on fhe dffies sUBed: S^�, / c�'7�- � o�s -� �� �5 � Requ�t�e �/ Ragh�n InspeUion Required? ❑ Yes ❑ No Inspection Other Than RougMn: �ady Now ❑ WNI Call ,�/ '�/ ,7 Vou must call the inspeda when ready! Date Ready. \ I cer�M' y ath t I am tlie �LICENSED CONTRACTOR 0 COA�ANY ❑ OWNER and hereby request inspecfion of the electrical wak at: