P - 78092REQUEST FOR ELECTRICAL INSPECTION
1"�F'J 1- 9 4 6� Minnesota Board of Electricity -
,.— 1821 University Avenue Suite S-128, Sairrt Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800�27-3529 www.electricity.state.mn.us
❑ NE REMO ❑ ADDITION ❑�E �IR Describe -using the back of the white copy 'rf necessary - the work covered by this request:
800
ALARM, COMMUNICATION, REMOTE CONTROI
GRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aonaratus � 5.50
��I�
���
Mile
IIIII IIIII IIIII IIIII IIIII (IIII IIIII I�III �� IIAI
15�79460
Ouldoor Liahtina Standard
_ j Transfamer I Power Supply fw Signs I OuUine Lighting @ E5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes ihe Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspec6on Trips Each Dwelling Unit �$80
Fee
Fee
(minimum total fee is $20) � ,�'j"Q, �S"�"j
iM15 MEA FIXi INSPECTOR USE Q1Y
I haeby ceNy tl�al I inspected the ek�cbical instaNaGon desuibed herein on the dates stated:
)ISCONNECTED IF NOT
� �� � �.
_-� � -�
G� � � ��.{! S
�-� a 30
Sa���
ReV� • Roughin Inspection Required? �Yes � No Irupedion Other Than Raugh-In: ❑Ready rbw II Call
/ You must wll the inspecta wh� readyl Date Ready:
I I am the ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at•:
i�:'.