P - 75528q REQUEST FOR ELECTRICAL INSPECTION I
1��� o� 4 2 5� Minnesota Board of Electricity I�,
. 1821 University Avenue Suite S-128, Saint Paui, Minnesota 55104
(651) 642-08Q0 TlY/MRS 1-800-627-3529 wwov.electricity.state.mn.us
De,aaibe -usin the�3ack of the white copy'rf - the work ered by is requast:
GENERAL FE S Outd�r Lightln Standard Q$1 i
SERVICES / POWER SUPPLIES Traffic Siqnal Standard a�. $5
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CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
TO THE
Per
BE
Ii �
I III� I� �I II �I li I� � I� � 10 � III �I I� ��II I�''�
18204255
C�I�i71iT
Includ� the Service and/or Power Supply up to 500 Amperes, M
Circuits and Tvro Inspedion Trips Each Owelling Unit @$BO
Add�ional Ins 'on Tri $20
Inv�figative Fee
Reins 'on Fee @ $20
TOTAL FEE �.0
(minimum total fee is $20) ,�� —
THIS AHEA FOR pLSPECipA II� ptUy
I irereby certify that I Nspeqed the etectricel insla0adon desrrl�ed hme6i on fhe def� sfa�ed:
aouca�w , unre
n�' � ,r �,.�
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Fl�-�Q- a 7 ��
F'OR (?FFlGE USE ONLY
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��_� T/ I Rough-in Inspedion Raquiredp ��'e,y ❑ No I Inspection Ofher Than Rough-In: 0 Ready Now VVip Call
`f You must call the inspec[or when ready! pate Ready
I certify that { am the ❑ LICENSED CONTRACTOR ❑ COMPANY p OWNER artd here6v rmn��p�t ��Q�,.r�,,., „�+tie e�.,.�.:....� .._a. �.