P - 79249REQUEST FOR ELEC�RICAL INSPECTION �
� r` 1� 0- 6 4 4 Q Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
NEW ❑ REMODEL ❑ ADDITIQ�Ep �E.P�B 12e�crjp� u�jpg„tr�b k o g�White copy if necessary - the work covered by this request:
�f t_ M RCaY SAVCK �.�h
IPOWER
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL
3 to 12 Units
Each AddiGo
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�77D6441
Transfortners u to 10 KVA $10
Transformers over 10 KVA $ 20
Transformer / Power Supply for Siqns I OuUine LighUng @$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
CircuiGs and Two Inspec6on Trips Each Dwelling Unit �$80
TOTALfEE I �O,�O
(minimum total fee is $20)
rws naEn voa wsaecrors usE aar
I hereby certiiy tl�a11 Ynspec6ed the elechical installalion described herein on tlie dales stated:
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Requesl0afe: Rough-in inspection Required? ❑ Yes ❑�lo Inspection Othw Than Rough-In: �Ready Now LJ Will Call j
�7�� You must call the inspeaa when .eady! Dale Reaay: I
I certiiy that I am the Oi�ICENSED CONTRACTOR D COMPANY ❑ OWNER and hereby request inspection of the elecVical work at:
INBTRUCTIONB ON BACK OF YELLOW COPY BOARD OF ELECTRICITV COPV EB-OOU01M10 8.7. 2O'