P - 76314REQIJEST FOR ELECTRICAL INSPECTION �'
2� o� 7� 15 �� Minnesota Board of Electricity
� 1821 Unive ity Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) - TTY/MRS 1-800-627-3529 www.edectricity.state.mn.
Describe-usin9v U//U' e co,py'rf necessary the�/ � this r�uest:
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SUPPLIES
FEEDERS
tM, COMMUNICATION, REMOTE CONTROL, SIGNALING
.UITS, CIRCUffS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDI110NS TO THE GENERAL FEES
fIFAMILY DWEWNGS PER UNI
3 to 12 Uni� (iD $50 Per Unft
FEES
THIS INSTALLATION MAY BE ORDERE
III�I ul�ll�q �lu ulu ulll IIIII IIIII �� I�
2087153g
Includes the Service and/or Power Suppty up to �0 Am�res, All
Circuits and Two Inspectlon Trips Each DweDing Unft @$80
Addidonal InspecUon Trips (a� $ZD
Investiaadve Fee
Inimum total fee is $20) � J V
nas att�a wa ws�croR u� ow.r
I Inspeded the electricel Installadon desaibed here6i on tlre daies s�ted:
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I cefify that I am
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CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request insp�tion of the elecfical work at
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SecUon e Fire No. Co
Please Provide ) P umbers Imiudir�g Area Code
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Et�trlcel Ut�ty Addr�s
Contredor Licsnse Num6er Mester Etectric�n or Prnroer Limited Techrddan
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Mner Perfurming I on) P ease Provid vro R%pn�,�be�s Ir�cWding Area Code
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