P - 76208REQUEST FOR ELECTRICAL INSPECTION
� � � � � � � � � Minnesota Board of Electricity
1821 Universiiy Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.edectricity.state.mn.us
D using the back of the white copy'rf nec�sary - the work covered by this requ�t:
� A) SP � l CD_ I(�C7 �'lM �,o
I SERVICES / POWER SUPPLIES
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUffS, CIRCURS OF LESS THAN 50 VOLTS
3 to 72 Units @$50 Pe
Each Addfio�l Unft @
OTHE
Liuhtfia Retrofit CrD. $2:
S ecial I� edion $30 er Hour
Sp�ial Ins on �$.31 per Mile
TFfIS INSTALLATION MAY BE ORDERED
I II�I II �� �I U� II ��I III I� (II II � II �II �� I�
21056189
Includes the Service and/or Power Supply up to SIIO Am�res, All
Cira�ts and Two Insp�tion Trips Each DwelGng Unit @$80
Add'i6'onal Ins�tion Trips @ $20
Inv�tiaative Fee
total fee is
et�trical
FOR flFFICE USE ONIY
�C'p JUN 2�8 2007
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�: Rough-in Ins�on Required7 ❑Yes ❑ No Ins�etlon Other Than Rough-In: 0 Ready Noav �WiO Ce0
�� /�� You mu� call the inspector when readyl Date Ready.
I certify that I am the � LICENSED CONTRACTOR � COMPANY ❑ OWNER and hereby request ins�cfion of the electricel worrc at
Job Ske Street Addr�s City
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