P - 78941cr� ❑ REQUEST FOR ELECTRICAL INSPECTION
1� V U�- 5 7 9 0 Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 551�4
(651) 642-0800 TTY/MRS 1-800�27-3529 www.electriciry.state.mn.us
EW ❑ REMODEL Q ADDITION ❑ REPAIR Describe -using the back of the white copy 'rf necessary - the xrork covered by this request:
1'� i'f �✓ ✓� V t�
0 to 400 Ai
401 to 800
2M, COMMUNICATION, REMOTE CONTROL, SIGNALING
;UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS T� THE GENERAL FEES
$40
lllnllllllllll IIII11111�111IIIIIII11111�� I�
0
Fee @ $20
io l010 KVA
I Transfortner I Power Supply for Signs / OuUine LighGng �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additional Inspection Trips @ $20
Investioative Fee
ivin�rc�
.4� �
(minimum total fee is $20)
iH15 AREN FOR INSPECTCR USE OKY
I hereby ce�0fy that I inspecffid the electrical insta6a6on dexnbed he�ein on tlre dates stated:
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1605579
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Inspection Other Than Rough-In: Y� � VYYII Call
�� �e: �gh-in Inspaction Required? � Y� Date Ready. . � � � � �f L
�� 1� �Q(� Vou must call the inspector when readyl � yrp� at:
�CENSED CONTRACTOR ❑ COMPANY ❑ OWNER and he�by reQuest mspection oi ihe electr�a
I cer6fy lhat I am the z;p code
Job Site Address (Stree4 B�, or Route No.) �ys��
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iiling AddreSS (COr�trecta, ComP�Y w�^� ���rg InstellaWn) �� � Q%� A'/�
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�� v � gppRp OF ELECTRICf1Y CAPV
ON BACK OF YELLOMr COPY
Masier Electriaen a
Lioense Number /�
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Eg_ppp01M14 8.1.2002