P - 75887REQUEST FOR ELECTRICAL INSPECTION
1� 9 6� °� � 0 � Minnesota Board of Electricity
1821 University Avenue Suke 5128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.edecri-icity.state.mn.us
Desaibe -using the back of the white copy r�ry�(��Q �sb✓ bYf�A/J� ���`i �
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CIRCUITS OF LESS THAN 50 VOLTS
3 to 12 Units
i Home Park Lois
Vehicle Parlc Sit�
'ALLATION MAY BE ORDERE
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Transformers over 10 KVA $ 20
Transformer / Power Suppiy for Signs / OuUine Lighting @$5
ONE & TWO FAMILY DWELLINGS, EACH UNR
Includes the Service and/or Power Supply up to 500 Amperes, All
Circutts and Two Ir�spe�cUon Trips Each Dwalrmg Unit @$80
TOTAL FEE
total fee is $20) �� �
I hereby ceNfy tl�at I i�peded tlre el�trlcel Urstallaticn d�d hereln on 9re dafes s�ted:
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JIPLETED WITHIN 12 MONTHS
FOR OFFICE USE ONLY
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��' Rough-in Inspeclion RequUed7 �'Yes ❑ No I n Other Than R �teady
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y���L+ � You must call the (nspedor when readyl Date Ready.
I certify that I am the, !7'LICENSED CON'fRACTOR ❑ CAMPANY ❑ OVNdER and hereby request ins�tion of the electrical work at
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