P - 780641-5Q0-090 �
❑ NEW ❑ REMODEL ❑ ADDITION
�/RI��A�Phri� ''Y �In�
401 to 800
REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of E�ectricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TfY/MRS 1-800-627-352 electricity.state.mn.us
'AIR Describe -using the back of the white cop� if n e - e work covered by this request:
- r � �
Outdoor Li htin tandard $t
Traific Sional Standard � SS
IALARM, COMMUNICATION, REMOTE CONTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Exh Svstem Device or Aooaratus F� 5.50
3 to
Mile
►Y I
���I IIIII IIIII IIIII IIIII IIIII IIIII IIIII �� I�
15000904
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 @$80
TOTAL FEE I �"�
(minimum total fee is $20)
THIS AREA Fpi It15PECip2 USE Otlr
I hereby tertify tlwt I inspecled the electrital insfalla6on described herein on tlie daBes sfNed:
�.� 573 7
�O S�
Request Date: Rough�n Inspection Required? ❑ Yes No Inspedion Other Than RougMn: ❑Ready Now ❑ VWI Call
j_� -(/ You must call the inspector when ready! Date Ready: (f - ^Q
I cefify that I am the �NCENSED CONTRACTOR ❑CONIPANY ❑ OWNER and hereby request inspection of the electrical work at: