P - 76272. + - �.
• REQIJEST FOR ELECTRICAL INSPECTION
1��� 1- 5 4 0� Minnesota Board of Electricity _� ;
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
' , (651) 642-0800 TTY/MRS 1-500-627-3529 www.electricity.state.mra.us
De.acrihe -using the back of the whRe copy if necessary - the work covered by this request:
E�CEL EhlE�:C;Y SA�E�'s SWT i CN
A�,ARM, COMMUNICATION, REMOTE CANIROL,
G�RC111TS, CIRCUITS OF LESS THAN 50 VOLTS
to 12 Units @$50 Per Unft
Park Lots 1
Park Sites
,LLATION MAY BE ORDERED DISCONI
Illl � al II I�I Il lli ll �l ��I ��I ��I ��I I II�
17975400
Traffic Sianal Standard
Transformers over 10 KVA $ 20
Transformer I Power Supply for Signs / Oudine LighUng @$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Fee
�v�ru.r�c ��v���,J
total fee is $20)
I inspected the electrical installalion dascribed hereln on the daf� stated: I
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TED IF PIOT COMPLETED WITHIN 12 MONTHS `_ __�
REC'D J UN 14 2007
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���' Rough-in Inspection Required7 ❑Yes �] No Inspection Other Than Rough-In: [�Ready Now ❑Will CaII
C{����� +� You must call the inspector when ready! Date Ready:
I ceitify t�at I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
.ton s� sa�t aad�a� �� F Fi T D L E f 9 hi I�!
17 F�TCE CF�EEK t��`t i�lE
O�rtiqrlOCCUpant Name Please Provlde Two (2) Phone Numbers Including Area
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Elecpical Utiiity ElecUiql Utility Address
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ConlraCior / Company Name Contrector License Number Master Electrician or Power L(mited l
HUh{T ELEGTFiIC �QfiF'QI"iP I IOh! �,�j ��$�� U�nseNumber
AAailirtg Adckess (Contractor, Company or Owner Perfortning Installation)
�;sC�O TEFiF:1TCl�:TAL E:Ot�ii9 �sAIh�T F'ALILq I�i�l 5511Q
Authorf�ed $Igtiature (Contractor or Owner Performing Instailadon) Please Provide Two (2) Phone Numbers Inciuding Area
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