P - 76083REQUEST FOR ELECTRICAL INSPECTION ��' �.
�� o��� 7 2 4� Minnesota Board of Electricity
/� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
l,� g'C� � (651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.sdate.mn.us
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Describe -using the k of the white copy'rf necessary - the work covered by this �equ�t:
i..� � 0.J�S o 11 � ��" S
f� GENERAL FEES Outdoor Liuhtina Standard C�D $1
0 to 400
CIRCURS OF LESS THAN 50 VOLTS
MULTIfAMILY DWELLINGS PE'.
3 to 12 Units id. $50 Per Unit
lIII u III II �II II III II II� II I�I � I� ���� I�
20627246
Transformers over 10 KVA $ 20
_ TransFormer / Power Supply for Sfgns / OuUine LighUm,7 Q$5
NE � T1N0 FAMILY DWEW NGS, EACH UNIT
Ir�clud� the Servi� andlor Power Supply up to 500 Am�res, AII
Circuits and Trro Insp�Gon Trips Each Dwe�ing Unft @$86
total fee is
I hereby certliy fhat I lnspeded me elecLical Mstallatlon descdbed hsrein on Ure da0ea at�d:
rCF: OfF;CE USE OhLY
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Rough-in Inspedion R�uired? ❑Y� �Na Insp�dien OfherThan Rough-In: ❑ Ready Now�WIU Call
�(�(y..� ��� You must call the irtspedor when readyl Date Ready:
I certify that I am the�L.ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER arM hereby request insp�tian of the electrical work at
Job, Site � Addr� �1 � �� City � 1
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Towrtship Sedion Range FUe No. Coyqly _
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Ave NE ���I-��i � u �` N���
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Please Provide Two (2) Phone Numbers
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Area