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P - 77128�^ REQUEST FOR ELECTRICAL INSPECTION �� 1!-� � 0 7 C� � Minnesota Board of Electricity �,� ;- �. 1821 University Avenue Suite S-128, SaiM Paul, Minnesota 55104 (651)642-0800TTYlMRS1-800-627-3529 www.electricitystate.mn.us ❑ NEW AAODEL ❑ ADDITION ❑ REPAIR Describe -using the back oi the white copy 'rf necessary - the work covered by this request: /�'o�'� �J'T ��/�.eE f�� T'io niil , cm SERVICES / ALARM, COMMUNICATION, REMOTE CONTROL CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Each Svstem Device or Aooaratus � 5.50 3 to 12 Units @ Each Additional fit � 5.25 per Fixtu2 rigation Boom � yl( Home Park Lots � S Traffic ONE � TWO FAMILY DWELLINGS, EACH UNIT Includes ihe Service andlor Power Supply up to 500 Amperes, All Circuits and Two Inspection Trips Each Dwelling Unil �$80 Additional Inspec6on Trips $20 � InvestiQalive Fee TOTALFEE _ (minimum total fee is $20) �o� . � TMS MEA FIX1 INSPECTOR USE OLr I hereby ceAify that I inspected the ekctrical instapa6pn described herein on the dates staled: �U `f — C'i G -7 � 1 f0 '� `�r i DATE �� n�v �nv 1 P1LLM I lyl� I�INi oc �RUCReu u�s�unnt� i tu ir nvT coMPLETED WITHIN 12 MONTHS �� Y4i: � . .. �r��r � � +� +s�: s�la� i.rr w.�! .:� �"^Q+� �%��%{'„�F:��.4��J�S�� _ i��;��`'�F�� S� �,SS� � � �,� � 9 7 b. 7 � ""�` �, �- ��.�,��`d' _ _ - � ;�,.. �.m-.. ; i� �.. s- _ '° � u� . '�us+J'i%��►fP � � � _ . � �~� .. :� - , �. . . r i� ar��`ca�� - o��r � c�F o� ��. _ : � �: - <. � �t�' � Gfl�c t/ �,r �i�'�� '� :� � . � � a � � � �� + ��il�:�/.�X'1'��, �� `�i� %� i� b Z t _ �- � �. i, .s q�, -, �/ - X � � � ,� � , _ . . ,. �� z �.. . � � - , F . : .�� ,� , � � �� !�l 'L'" �. L ��JV�i - �i �� " � �- . a owner Par�arnwg k�Wtion) "" � �. �' . � , �. .a =;. �� ,F� 1 .5�.� � ��. .....Y. .. , '`'i .. ,l/< _'^="° P''°"° cs� �r� -, � �r �'-` ;�r.= . _ � �,� � - ��- . ��