P - 78778�1 REQUEST FOR ELECTRICAL INSPECTION
1�`t C3 �- 3 3 3 � Minnesota Board of Electriaty
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 llY/MRS ]-800�27-3529 www.electricity.state.mn.us
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I ���v� � Hru�Jurv _ u�rctYAIK uesc -usmg thep�k of e white copy d necessary - the work covered by this request:
Traffic
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�' ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am e$10 Ir�ludes ihe Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circui� and Two Inspection Trips Each Dwelling Unit @$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS ea�a�......i i.......,.�:__ r___ �..,,,
3 to
TOTALFEE
S50 P� Unit (minimum total fee �$20)
Unif �$25 Tmsuu� Fors aa�cTae usE aar
I hereby cerUry Ihffi I i the inslaAaion Aescribed herein on Ihe da�s sfaBed:
OTHER ADDITIONAL FEES /�FL�- � � °�
5.25 er Fixture K, f�( �"� ��
260n 600rt1 $4� naxw w �� o�re
ome Park Lots S25
I11C�C P2II( SI(CS aS F,��TKK+ p�TE
i Ins tion $20 �-Z $'- o
M p$30 cer Fbur ���fo ti.�
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14833339 `� �03`7(�
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I c�rtify lhat I am the
INS7RUC11pNg ptl�BACK OF
�Q� 398� a 5, sc�
Roughin Inspectipn Required? O Yes ❑ Np Ingpecyion p�h� Then RqigMn: y Np�y ❑ yy�l Cap
Yau must call the inspector when ready! Date Read .
Y
NSED CONTRACTOR ❑ COMPANY ❑ OWNER and t�ereby request insp� ���I ��:
t9-00001M74 8.7.2002