P - 79662, REQUEST FOR ELECTRICAL INSPECTION
�2 2 4 2 4 g �� Minnesota Board of Electriciry
� � 1ffit University Avenue Suite 5-128, Saint Paul, Minnesota 55104
«a*�-�. (651) 642-0800 TTVlMRS 1-800-627-3529 �.
- tvww.eleciricity.state.mn.us �.��� �'
Inclutles ihe Service and7or Power Supply up to 5W Amperes, All
CIRCUITS OF LESS THAN 50 VOLTS
3 to 12 Units � 55o Per Unh (minimum total fee is $20) 8'�'
Each Atlditlonal Unit �$25 foa ��a,oA � o.�.
OTHERADOITIONALFEES �'�2u«—I'37�"�j� ���
C htin fletrofit 0 525 er FiMUre �8� �p"
Center Prvot hi tion Bcom � 540
M3fluhCfwEd Hom¢ PBfk LOIS �§25 I hereby ceNly Ihet I inspetletl Ihe elecNCal insfallalion tlesr✓Ibetl herein m Ne tlates slatetl:
Recreationel Vehide Park Sites � $5 '" �
DTE
Se arete Bondi Ins clion �$20 ���—"—� �%S 6"
S ecial Ins ction �$30 r Hour ""1N9°F01pH - � °""
5 eciel Ins ction �$31 r Mile f 6 ��---� =�1� �
_ Twic tNS7nLLA710N MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOF OFFICE USE ONLY
I IIIN! illli Il1411ii{N{III1ffN Ilffillfll iilli111 n u
N 1 2 2 4 2 4 B 3 3t /C��v ��-SL?
1 1 � � � ��( � xou must call the inspector xTen reaRy! I p� q ry�. I
I ceNfy ihat I am ihe CENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspectlon of ihe electncal work at:
,bb Atltlress (Slreet, Boz, or Raute No.) Ciry Zip Cotla
74^c1 tIHIVERSITY AVENUE N FkIDLEY� MN
Phone
1'�1 %, `�r � e� � .�t
Eleqrical Conhac�or / Company Name Contrector Li�xnae Number
MIK-LYM ELECTRIC C0. CA81246
��d ����9 ���ss l��eclop Companv or Owner Penn.mio,, i�tmn�r,,,m
CHAMVLIN,_MN 5.°.,316
BOMDOFELELTqICITYCOVY �� qJSTqULT10NSON