P - 78567� /� p ❑ REQUEST FOR ELECTRICAL INSPECTION
1��F � C? - 7 81 1 Minnesota Board of ElecVicity -
1821 University Avenue Suite S-128, Sairrt Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-8 27-3529 www.electricity.state.mn.us
❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR Descri - mg e ack e whde copy'rf necessary - the work covered by this request:
i.tJ/Rf'_ F4%2Nf}�`� !Q'�� ��/1/D
AtARM, COMMUNICATION, REMOTE CONTROI, SI�
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device w Apaaratus 6D E.50 .�
I
Unit
5 ep r FixtuB
800m @ E4L
IIIIIIII�IIIIIIIIIIIIIIIIIIIIp���N�l�
14087811►
TraRc
Transfortners over 10 KVA $ 20
Transfortner I Power SuDDIy for Sians / Outline Li�h6nq $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Grouils and Two Inspection Trips Each Dwellirg Unit � E80
Fee
ivin�rrt Sp
(minimum total fee is $20) �-p �
na u�w wre u�crars usE aar
1 hereby cer6fy tliffi I inspecBed the elecbical instaMa6on described hudn on Ihe dales sG6ed:
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I ecoquesc ua�e: Rough-in Inspedion Requrcetl? < t 4J Yes �$' I�NO I Inspediai OTher Th� Rough-ln: �Ready Nav ❑ Wpl Call
,3 6 /
� p� Q 3 You must caq the inspecta when ready! Date Reedy. .
I cefiy that i am the ,�l UCENSED CONTRACTOR ❑COMPANY ❑ OWNER and hereby request � of 1he electric�al wak at: