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1475L341
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Request Date: Rough-in Inspedion Required? �' es
Inspection Other Than Rough-In: ❑Ready Now II Call
3- 2 2- 0 4 You must call the inspector when ready! Date Ready:
I certify that I am the �ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request mspecfion of the electrical work at::
� -475-134 �
❑ ADDITION 0 F
�� �
SERVICES I
ALARM, COMMUNICATION, REMOTE CONTROI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus E.50
ADDITIONS TO THE GENERAL
3 to 12 Units �$50 Per Unit
Each Additional Unit @ L25
Mile
1Y I
REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electriaty -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651)642-080011Y/MRS 1-800�27-3529 www.electricity.state.mn.us
2 Describe -using the bxk of ihe white copy 'rf necessary - the work covered by this request:
n . . �
Standard
� Transtormer / Power SuDply for Siqns I Outline Li�htinq .$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspec6on Trips Each Dweiling Unit @$80
Fee
TOTAL FEE
(minimum total fee is $20) ,�.�� " �
iHIS AREA FOR IN$PECTOR USE OMY
I hereby certify that I inspected the electrical installation described herein on tt�e dates stated:
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