P - 79018REQUEST FOR ELECTRICAL INSPECTION �
��� 2� 0 Q 1 � Minnesota Board of Electricity � �:
, 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800�27-3529 www.electriciry.state.mn.us
❑ NEW ❑ REMODEL ❑ ADDITION REPAIR DescTibe -using e ack of the white copy if necess�r - the work coveied by this request:
0 to 400 Ai
401 to 800
ALARM, COMMUNICATION, REMOTE CONTROL, SIG
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus �$.50
ADDITIONS TO THE GENERAL FEES
�
czoter
Outdoor
Standard
i ranstamers over � u�vn b�u
Transformer I Power SuDPIy for Signs / Outline L'ghting � ES
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Grcuits and Txro Inspaction Trips Each Dwellirg Unit @ S80
(minimum total fce is $20} � p� V'��
rH�s u� Fon xaaEaort usE aar
I hereby ceAify that 1 inspec0ed the ele�bital i�taAation desxibed herein on Ihe da�s slaled:
N� �' 1`y
7 f �— U
x:�,�e� y�r€�s��ar�� r_isN. r�;iL.Y
.. �� � �-Er �l � �`' �
11111NNIIIi1111111111IIIiIIIiNIIUIN � � �� ��
1 6 2 2 0 0 L 4
a od�- l,b'� �� � �
Roughin Inspedion Required? Yes Inspedion W�x Than Now ❑ WNI Ceb
You must call the inspedar when r�dyl �be Ready: .
I oertify Uiat I am ICENSED CONTRACTOR ❑COMPANY ❑ OWNER and hereby ►e�t nspection of Ihe elactripl work at:
�c� `I�, `��c���,e:e.c�- �. �� � I.��,►, 5 .5t1-� �
�a
��� �r
�����
c
�a
��
�Pf -l�
�.�,,,.,. a,. �