P - 760061 9 71 7 5 4� REQUEST FOR ELECTRICAL INSPECTION
� � Minnesota. Board of Electricity
1821 University Avenue Suite 5-128, Saint Paul, Minrre�ota 55104
(659) 642-08001T(/MRS 1-SOOd'i27-3529 www.electricity.state.mn.us
D�scribe -using the back of the white coPY ff ne�ssary - the work covered by this requ�st:
�'�,r�t,L �. � .
GENERAL FEES Outdoor Liahtina Standard C�D $1
0 to 400
ALARM, COMMUNICATION, REMOTE CONTROL, SIGI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or Apparatus $.50
ADDITIONS TO THE GENERAL FEES
CeMer Pivot irtfaatlon Boom
Transformers wer 10 KVA $ 2(I
Tramiormer / Power Supply for Signs / Oui
ONE 8 TWO FAMILY DWELLINGS, EACH UNI
Includes the Service and/or Power Supply up to
Cirari� and Two Irrspectlon Trips Each C
Aq
$80
TOTAL FEE � p /Os
(minimum total fee is $20) 'T �
'Rm4 AREA FOR aLSPH.ROfl Ilff Ot�dY
02� Poi�t j�
I hereby certHr that I in�cted the etectrical installadai d� herein nn the dates a�ed:
1 THIS INSTALLATION MAY BE ORDERED DISCONNECTED 1F NOT COMPLETED WITHIN 12 MONTHS �_��
FOR OFFICE USE ONLV � j���
(IIII II W ulll �lu �IIII II III II III II III �� IUII �
19717545 �����
� °' �c��
� � ���
�: � Rough�n hrepectlan Requtred7 �� ❑ No Inspecdon Other Than Rough-In: ❑ Ready Now CeA
�+ _��� You must cell tlre inspector when ready! Date Ready.
I certify that I am the �y10ENSED CONTRAC70R 0 COMPANY ❑ OWNER and hereby request inspe�ion aF the el�rical vaork at
.�bS�� � 4���u ��---- 2 �- � �1'c.I� c� '�"� � `7
�v.r.ir L e � �.
� ��� /�
�
r.
e���
an� �wrnar renormu�g 1 wuuwn� /° w
iht% ��,� ��/�
or Owner Perf rrN �InstaOation`� ('
�
�
b0f Me&er Electrldan or PoNfBr Limttetl �
3 `�.,, u� Nwnbe.
''7
�� ��� SS� �
4wide Twa (2) Phone Numbe�s Includ(ng Ares
�C�°'�9'4�i� )
c4 nnnme �a
�