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P - 781451-5�50-753 ❑ REMODEL ❑ ADDITION 'a-RI �,�M.,�O � �l e� � I Above 2IX1 Ampere �510 ALARM, COMMUNICATION, REMOTE CONTROI CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Each Svstem Device or Aooaratus � E.50 Unit � SI�S � � S2 ow Hour �� ) �� 155�7536 REQUEST FOR ELECTRICAL INSPECTION Minnesota Board of Electricity 1821 University Avenue Suite S-128, Saint Paul, Minnes�a 55104 (651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us 2 Describe -using the back of the white copy 'rf necessary - the wak covered by this request: _ f 7ransfamers up to 10 KVA @ Et 0 T Tr�sformers over t0 KVA �.1 E 20 Transfartier / Power SupdY ��9ns I Outline Liqhtinq � ES ONE & TWO FAMILY DWELLINGS, EACH UNIT Includes ihe Service andlor Power Supply up to 500 Amperes, All Circuits and Two Inspection Trips Each Dwelling Unit � EBO Additional Inspection Trips � S20 - InvestiaaGve Fee TOTAL FEE (minimum total fee is $20) vZ �•.S� THS NIFA FOR M6PECTOR USE MY � �1Ml� �� Ill� dl! �IC3� 11�011 �SGI� �1lfE111011 dIC 4�5 5�: r ZQ-- ��a5�8 ��yQ� �Q�'% - �roS� a o .sv Requesl Date: RqigMin Ir�spe�tion Ftequired? ❑ Yes No I nspedion Olher Than RougMn: Now � Wfll CaN si �� ,� You must tall the inspector when ready! pete Rp,ady. I certiy that I am the � LICENSED CONTRACTOR ❑ COA�ANY ❑ OWNER ar�d hereby �equest inspection of the electricai work at: .iob sae Ndaress (sc.�. Box. w�ne ra.� c.�y zp coae 3 6 � �� s 3� Sedion Towns 'P Range Fire No. Cau /� t 7"F/-� d I�iGL� Owner/Oxupent Nmne Ple�se Provide Two (2) Phone Nwnber(s) Indudng Area Code s f� /YI o 6 ��lG ,�, e. (�6� �go -, 3so c) �� .�� Sf� �. f �. � �, ,a lS � ec� i� �,ya�, �, ihG :«��Y « r � I (� �� ru�«,> s� �v � ,' ewc�c o� �E�-ow �or+r eonqo oF �crnicm coPr � ucense N�r„oer r � is m � ss�13 � �S� � �- - B �fo -115� EB-0OOO7Mt4 8.1.2002