P - 77314REQUEST FOR ELECTRICAL INSPECTION
1- 614 - 0 6 5� Minnesota Board of Electriaty
1821 University Avenue Suite S-128. Sairrt Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
❑ NEW REMODEL 0 ADDITION ❑ REPAIR Desaibe -using the back of Me white copy rf necessary - the work covered by this request:
/� �._//,. ._
4ot to 600
Above 800
ALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device w Aooaatus � E.50
3to12
�
MAY I
illl il l� lilll II III IIIII II �!I II III II III III� I�
1 6 L 4 0 6 5 9
to 10 KVA
� Transfortner / Power SuDdY fa Signs / Outline Lighting . a5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Grcuits and Two Inspection Trips Each Dwelling Unit @ 580
Inves' ativeFee
Reins tion Fce E20
TOTAL FEE `' �s-�
(minimum total fee is S20) ' j�CP �`� u
iH5 /JiFA FOR I6ffCTOR USE dlY
� �1EfE� Clf�(p � � III� tl1E C�BCbIC� II� � �1UERI 011 dIC d�5 �:
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��� Raugnin a,specUo� Requ� t �a ves u No trape�on ou,er,her, rtougn-M: o I
Resdy Now � WAI Call
s-'�'l �� You must caY the mspecWr wha� ready! �6e Ready.
I oerti(y that I am the �, LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspec.ibn of 1he electrical work at: