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P - 77441/�7 ---- QE�UESFfOR ELECTR/CAC iNSPECrioN �. `t' I- 3 5 9 Minnesota Board of E��,�,cy�, ---- 1821 University qvenue Suite S-128, Saint Paul, Minnesota 55104 «1) �2"��0 TTY/MRS 1-800-627-3529 H'►vw ctricity.state.mn.us �: �dentify the work covered by this request: ❑ NEW ❑ REMODEL ❑qDDITION $� C-C�/! /L � � EPAIR S ICES / PpyyER SUPPLEES � FEES l Q�' � Outdoor Li hti Standard � $� 0 to 400 Ampere (� $25 Tralfic Sianal Rta�,�� w, e� �T a ��ansrormers over 10 Kyq r� $20 �$5 Transformer / Power Su 1 for Si ns / Outline Li htin (� $5 e�$�p ONE 8 TWO FAMILY DWELLINGS, EqCH UNIT TION, REMOTE CONTROL, SIGNALING �"��u� the Service and/or Power Suppry up to 500 qroperes, Ail OF LESS THAN 5p VOLTS Circuits and Two Inspection Trips Each Dwellin Unit �$gp ce or ratus �$.5p Additional Ins ion Trins � R�n �„ �,��Y (minimum total fee is $20) cx� �s� /�� — �3�7— �t �f- � �� , a � n.� �o ��,� aertify that I inspecyed the electrical instaNatan wouon w described herein on the stated: wre ,. iwti insPecnoN �� o �� ?. Q - . -- •• ••�• ..vmr�t�ED WITHIN 18 MONTHS � �c� usE orp.Y - --- _— _ I � �� - �� Illllllfllll IIIIIIIIII II � � 1 3 4 7 3 5 9 O l� � ,3,,,ph.k, ,,,,p,ctld, �ed� �g G� -� (v?8 GI � •� 1 Y�, ��+� �„�,,,�,a„ "° '� o�, rn� R�,.M: a,�, r�„ wu, c� i �rr �c i me ❑ uca�o `«°ri , °� �,r: co�r�ncrc� ❑ co��wr � �a ,b,e�, � �, a a�e � � �r � � cs+�. �X, a R� r�.� : �, ua ST f-- ` � � _s.�, T� �„0.� �►�., ' �1�U 5�',3 �_ � � ,...�. � _ � � _ �Q �. , �'°°e � � '�'s�' � �- — 7 "� 2 � �� _ � t E� f � , � �� ► �kanse N�xnber � � � �6 � Y a Owner r°rr°�e ��,n> � • � �„�r�d _ I < . Cor�er�y or �� j Phone j _ " �G 3 �/7 =-�2 �'Z ; ` � ��