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GENERALF S
401 to
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CIRCURS OF LESS THAN 50 VOLTS
iystem Device or Apparatus @ $.50
ADDffIONS TO THE GENERAL I
Manufa�ued Home Park Lots
REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity '
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.sdate.mra.us
- the work covered by this r�uest:
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Outdoor Liahtirm Standarcl Ca� $1
I THIS INSTALLATION MAY BE ORDERED
II�I �I IU II Ill II I�I II I�I � IU II III U��� I�
189�4591
Tiansformers over 10 KVA $ 20
Transfortner / Powrer Supply for Signs / Outline Lighting @$5
ONE 8 TWO FAMILY DYdELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Am�res, All
Circuits and Two Inspection Trips Each Dvreuing Unit @$80
total fee is
I hereby cerdfy thet I inspeded fhe electrical U�sfeVatlon d�cnbed herefn on fha dat� �ated:
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FuR OFPiCF U5"t ONLY �
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I��� �� Rough-in Inspedion Required7 �Yes ❑ No I�p�tion Other Than Rough-In: 0 Ready Now �IVpI Ce0
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You must call the tnspector when readyl Date Ready:
I certi(y that I am the LICENSED CONTRACTOI� ❑ COMPANY ❑ OWNER and hereby request inspection of the elechical wark at
Job Site Street Add C,� n'� y,�' /
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cense Numner master eie�xndan or
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