P - 78674REQUEST FOR ELECTRICAL INSPECTION �
1 � 4 4 � � � � � � Minnesota Board of Electricity .r.. ,_ ;
1821 Univereity Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
O NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of the while copy'rf necessary - the xrork covered by this request:
� � ���1 t° � � S � IP.0 � � C- �G ,
200 Ampere �$10
)MMUNICATION, REMOTE CONTROL
CIRCUITS OF LESS THAN 50 VOLTS
ivstem Device or Aooaratus � 8.50
3 to 12 Units
Eadi Additio
Mile
I I I I I I I I I I I I I I N I I! I I I I I I I I I I I I I I I I i I I I� I I I I I N!
1 4 4 8 L 1 3 9
0
� Transiormer / Power SuDdY for Signs I Outline Lightinq $5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Grcuits and Two Inspection Trips Each Dwelling Unit @ E80
��in�ret
(minimum total fee is $20) 0� sd
THIS MEA FOR NSPECTpt USE OKY
I hereby cer6y that I inspected Ihe electrical insfallaGon des�ribed herein on the dafes sf�ed:
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�11�50
°`r'ti" "' RougMin Inspection Required? Yes ❑ No Mspedion Olher Then RagMn: ❑Ready Now I Call
/ 3�0 3 You must cal� the inspecta when ready! pete R�dy
I certify that I am tl�e �CICENSED CONTRACTOR ❑ CON�ANY ❑ OWNER and hereby request inspecbon of 1he elecUica� worlc at;
E&00001M74 8.1.2002