P - 75876REQUEST FOR ELECTRICAL INSPECTION '
I J. e��� 15 0� 8'21 Uni�versity Avenue 8uite S-� 8, Saint Paul, Minnesota 55104
` �� (651) 642-0800 TTY/MRS 1-800-627-3529 www.edectricity.state.mn.res
� Describe�fising the bacJrtbf the white copy if net�ssary - ey9rk covere�i P this requ�t: ,
GENERAL
I SERVICES/
CIRCUITS OF LESS THAN 50 VOLTS
ivstem Device or Ao�atus C� �.50
��
Pivot
Traffic Signal Standerd @ $5
Su lemerital Fe.e @ $ZO
Transfortners u to 10 KVA a$10
Transformers over 10 KVA $ 20
Transformer / Power Su 1 for SI ns / Oufline Li hti $5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includ�s the Service and/or Power Supply up to 500 Amperes, Ail
Circuits and Taro Inspectlon Trips Each Dwellir�g Unft @$BO
Addffior�al Ir�s�ction Trios (rD $20
TOTALFEE
(minimum total fee is $20)
7l69RlffAFORPI4PEC�WiUg Y
I hereby cerUfy that I inspected the eledricel k�tellatlon desatbed trereln on tlts datea st�ed:
arnaa�w pq�
reen.w� - oah
� `��i G�
5 � Iruspectian (a� $.37 r Mile
THIS INSTALLATION A�AAAY BE ORDERED DISCONNECTED IF NOT COMPLETED WF�HIN 12 MONTHS
r-oR �Fice use or��v �,� �`a -zq_ 0 5'
IIIIIUIIIIIUIIIWIIIIIIIII�II��IIW��I� ��"g
1 9 5 1 1 5 0 0 �Q������ �
�' Rou h-1n Ins
�� °/� �� g pectlon Requhed? ❑ Yes ❑ No Inspedlan Ofher Then Rough-In: Ready Ptow ❑ Wip Ce11
You must cell fhe inapedor when r�dyl Date Ready:
I certi(y thet I am the I�ICENSED CONTRACTOR ❑ COMPAIVY C] OWNER and hereby request inspection of the electrical work at
,ion sroe street aa ' � � ,. , _ � � cnv .,
y yi,!� !
I �� � ��vl�'� �,�-�_--
WSTRUCTION9 ON 6ACK OF 0 CO BOARO OF ELEi:1R1�' COPV
(�1E1� ,e )
�se Number Master �erfiidan Power Limlt� T
� ��N��� �
Please rovide Two (2) Phcrre N�unbers Including Area Code
\ / e� � C�
FA MM111 a IC n � �m��