P - 75915REQUEST FOR ELECTRICAL INSPECTION
1�� 6�� 5 0 7� Minnesota Board of Electricity
1821 Unnrersity Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.elechzcity.state.mn.us
Descri� -using the back af the whfte coPY if n�sary - the wark covered by this requ�st:
�1�TER �1 RI� �T�W1C�
o co
)MMUNICATION, REMOTE COMROL, SIGNALING
CIRCURS OF LESS THAN 50 VOLTS
I MULTIFAMILY
Park Lots
�LLATION MAY BE ORDERED
�Illllllllllllllllllllllll��lllQ�f��l�
19635077
Ttannsfortners over 10 KVA $ 20
Transformer / Pov+er Supply for Sigrrs / Outline Lighdng Q$5
ONE 8 TWO FAMILY DWELLINGS, EACH UNR
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspecfion Trips Each Dwelling Unit @$80
I
TOTALfEE �1
Inimum total fee is $20) � . �V
TMS Al�h FOR PlbPECfOR USE OMY
I f�pected the electripl inatalleticn descrih� hereln on fhe dat� s�ed:
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NOT COMPLETED WITHIN 12 MONTHS _
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�' Rough-in Irrepectlon R uired? �es ❑ No I
5� o� aq nspectlon Other Than Rough-In: ❑ Ready Now Call
You must call the Inspector when readyl Date Ready:
I cerMy that I am the CENSED COfdTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
!6 i9 � �3 �dl �v NE � �3 F� ��Y
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any or Owner Performtr�g InstaOatlon)
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or Owner Perfortnirm Installationl
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oer me�0r Elearlclan or
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