P - 78658REQUEST FOR ELECTRICAL INSPECTION
1� 4, 1%� 7 g�, Minnesota Board of Electricity `- :
� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mry.us """'�
�IEW ❑ REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy'rf necessary - the work covered by this request:
I POWER SUPPLIES
IALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
MULTIFAMILY DWELLINGS
3 to 12 Units @$50 Per
Each Addi6onal Unit � I
Boom
Fee @ 1
JD �0 �O
Transformer I Power Su I for Si ns I Outline Li htin S5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes ihe Service andlor Power Supply up to 500 Amperes, All $ 0
Circuits and Two Inspection Trips Each Dwelling Unit � 580
Addilional Ins 5on Tri $20
Inves6aative Fee
TOTAL FEE I ��
(minimum total fee is $20) •
THIS AREA fOR IlEPECTOR USE QLY
i hereby cer6y that I inspected the electrica� install�on described herein on the dales sf�d:
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Request Date: Rough-in lnspedion Required? Yes ❑ No Inspection Otfier Than RougMn: �Ready Now O Will Call
5- 6— 0 3 r� must call the inspeclor wh reea�! Date Ready: .
I certify that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of tt�e electrical work at:
Job Site Address (Straet, Box, or Route No.) Zip Code
1150 NORTON AVE NE FRTI�T.Fv
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IXCEL
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24 LAKE�A,,�1D AVE N BROOKLYV PARK MN
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nnaster rrecmaan or
License Number
55428
763 537-08p7
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