P - 77226REQUE�7 FOR ELECTRICAL INSPECTION
1- 7 4 6-16 5� 82; �°� B°�� �ES �'s 28, Sairrt Paul, Minnesota 55104
(65 ) TTYIMRS 1-800-627-3529 www.electricity.state.mn.us
❑ NEW ❑ REMO%�L❑ ADDITION REPAIR^ � -using the ihe white capy'rf n - th work covered by this reQuest:
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SERVICES / POWER SUPPLIES
CIRCUITS OF LESS THAN 50 VOLTS
3 l012 Units @ t50 Per Und
Each Additianal Unil � S25
800111
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I I��! II I I I II III I I il! II I II II I II II III II II I�� I I�
1746165�
Traffic Sanal Standard
Includes the Service andlor Power Supply up to 500 Amperes, All
CirouiLc and Two Inspection Trips Exh Dwelling Unit @ S80
(minimum total fee is $20) � p��„� �y V
Tws u� wa ras�cra� us� orar
I hueby cer6(y tl�at I inspeckd the elechical instalalion daaibed haein on Ihe da6es slakd:
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00 - �o���
a s
rceQ ua[e' Roughin Inspec�on Required7 LI Yes LI No Inspection Other Than RougMn: �Ready Now LI VKII Cell
/� - O� You must call the inspecta when ready! Date Ready. /`
I cerlify that I am Qie ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request i�spec.•tion of the electrical work at:
) cay � , z�p Cade
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Sedion Township Renge Fre No. Cou
� �
Owr�/Oaupanl Name � Pleese ' Two (2) Phone Number(s) Induding Area Code
!�I c,l, D/IJ1 s2Y1 ( �`71, �/�'"
ELECTRIC, INC.
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Lioense Mumbe. .
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E600001M11 8.7. 2002