P - 78349REQUEST FOR ELECTRICAL INSPECTION
-���`t 1- 3 3 8 �� Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
_;
www.electriciry.state.mn.us � � i``
Identity the work covered by this request:
❑ NEW ❑ REMODEL �ADDITION ❑ REPAIR�—' �Q'C GG( �- � / / `�
rcu�oni r� V
�
IITS OF LESS
Device or Aoo
3 to 12 Units �$50 per UnR
to 10
� rcnsrormer i rower 5u i for Si ns / Outline L' Min �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Senrice andlor Power Suppty up to 500 Amperes, AI�
�ONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwellin Unit (� $B(
50 VOLTS Additional Ins ection Tri s�$20
� $.50 Inves6gative Fee
I hereby cerWy that I inspected fhe
tOG'll f82 IS
rein on the
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a eciai ms ecnon � g.31 er Mile �" ��" " �„� �
_ THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF COMPLETED_ WITHIN 18 MONTHS
_ _ _ _ --
FOR OFFICE USE ONLY
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Req=est pate: � Rough-in Inspection Required? Yes ❑ Na Inspection Other Than Rou h-In:
��7 � g ❑ Ready Now wIl Call
� You must call the inspector when ready! . Date Ready:
I certi(y that 1 am the ❑ LICENSED CONTRACTOR ❑ COMPANY OWNER and hereby request inspection of the electrical work at:
J��/ �(S ` t nr � ute� � C� � � �/ K Zi Code �
P
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,7
Section Township� Ra� Fre No. Counry
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�Pa��,e� N�� G � �vt s
Phone
76 3-7��-SG�3
Power Supplier Addres
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Electrical Contractor / Company Name Contracto� License Number Master License Number
wnlf/L. 30
Mailing Address (ConVactor, Comp�y or Owner Pertorming Insta tion)
S�/� M �
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EB-00001A-13 7/1/2000
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BOARD OF ELECTpICRY COPY � INBTHUC7ipNS ON BACK OF YELL�V-COPY