P - 75782REQUEST FOR ELECTRICAL INSPECTION �"'`
1� 9 2 4 �'# � 0 � Minnesota Board of Electricity
1821 Universily Avenu S-128, Saint Paul, Minnesota 55104
(651) 642-0800 00-627-3529 www.electricity.state.mn.us � '�
De�db� us�ig th,,gback of the whiteFopy if necessary - the uvodc covergd by, �t:
800
ALARM, GOMMUNICATIOPI, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCURS OF LESS THAN 50 VOLTS
Eadi S Istem Device or Ap aratus @$.50
ADDITIONS TO THE GENERAL FEES
3 to 12 Units @$50 Per
Each Additional Unit C�D :
'ALLATION MAY BE ORDERE
I�II ��I II�I IIIII �I� III� II�I QIII �� I�i
19244805
Outdoor Liahtinn StarMard
Transformers to 10 KVA $10
Transformers over 10 KVA $ 20
Transformer / Pmroer Su I for Si s/ OuUme Li Mfn $5
ONE & NVO FAMILY DWEWNGS, EACH UNIT
Inciudes the Serrice andlor Power Supply up to 500 Amperes, AII
Circuits artd Two Insp�on Trips Each Dwelling Ur�t @$80
Add�tlonal Ins 'on Tri $20
Im ' ative Fee
RemspecUon Fee $20
TOTAL FEE
(minimum total fee is $20) �
nusu�ar�+�ugonav
I hereby certHy thet I inspeded the dectrical 6�staDatlon d�aibed herein on Ure detes sieled:
IF NOT COMPLETED WITI�
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�' Rough-in Inspectlon Requlred7 ❑ Yes �o Inspection Other Than Rough-In: Ready Now ❑ WN Call
t7� ��/WJ You must call the inspector when readyl Date Ready. �„ �, b
I certify that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby ►equest insp�tion of the elecfical wrork at
IPWIRYLIIVIY.`iV1Vtlpl:RVFTELLOWGOPT BOARDOFELECTRICIT/COPY FR-(IMMtA-15 R1 �I1t1A