P - 78867REQUEST FOR ELECTRICAL INSPECTION �
1� 4�� 5- 9 5 3� Minnesota Board of ElecUicity '
.- 1821 University Avenue Suite S-128, Sairrt Paul, Minnesota 55104
(651) 642-0800 TlY/MRS 1-800�27-352 .electriciry.state.mrr.us
❑ NEW ❑ REMODEL ❑ ADDITION ❑ RE Describe -' th b
ALARM, COMMUNICATION, REMOTE CONTROI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
to 72 Units �1 a50 Per Unft
II�II IIIII IIII� IIIII II�I� I�I�I �I�II IIIII I�� I�
14659536
� ceAity tliat I am tlie
W�87RIIC110N8 ON
usmg e ac of the white y d - the work covered by this request:
�
Outdoor htin Standard $1
Traffic Si nal Sfandard ES
Su lemental Fee $2(1
Tr�sfamers u to 10 KVA $10
Transformers over 10 KVA E 20
Transfortner / Power Su fa S' ns / Outline Li htin 35
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes ihe Service andlor Power Supply up to 500 Amperes, qll
�NALING CircuiLt and Two Inspecfion Trips Each Dwelling Unit � a8p
Additional Ins tion Tri $20
Inves' ative Fee
� Reins tion Fee $2p
TOTAL FEE
(minimum total fee is $20) Q,
„ns u� wn rsrEC.ae us� «a.
I herepy ce�MY tlwt I inspecled tlie elecYical i�taYaYOn daail�ed hadn on tlie da�s sl�ed:
aax� W
UATE
FWLLN9PECiqN . }� vMTE �,(
� E7�IRED/A&WOIED �` . �. �J� WZC'��`
WTE
ED DISCONNECT D IF NOT COMPLETED WITHIN 12 MONTHS
� ,� �a�_� . k-:N�
2�.��
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� -� •-.......,�, ..�wred? ❑ Yes No InsPection Ofher Than Rough-In: ReadY Now � VVNI Cell
You must call the insp� �� �dN �� R�Y
NSED CONTRACTOR ❑ CpMPAP�y ❑ pWNER and hereby r¢quest inspection o( }� e�l work at:
Rti n� u.. � .
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