P - 77003R
REQUEST FOR ELECTRICAL INSPECTION
2����- 9 3 8 Minnesota Boerd of Electricity
� 1821 University Avenue Sufte S-128, Saint Paui, Minnesota 55104
(65'la 642-0800•TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
i Describe �sing ihe back of ihe white oopy 'rf necessary - ihe work � by tlus request:
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Above 200 Am ere $10
ALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S Device or ratus 5.50
ADDITIONS TO THE GENERAL I
3 to 12 Unifs
rr�r�ro� o��r,o Kvn a 20
Transformer / Power Suppy for Signs / Outline Lighfirq� �$5
ONE 8� TWO FAMILY DWELLINGS, EACH UNIT
Indudes tlie Service andlor Power Supply up to 500 Amperes, All
Circuits and Two inspection Trips Eadi DwelGng Unit @ S80
TOTALFEE
total fee is 5201
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I haeby certify that I inepected tlie elecUical insisllation desai� n on tlre dates afsted:
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'�A�pN MqY BE ORDERED DISCONNECTED IF NOT COMPLETED VYITf1lN 12 MONTH�
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I certifylhat I am the J
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RougMn Inspecfion Required? ❑ Yes No I�repedion Otl�er Than Raigh-In: ❑ Ready Now tll Call
You must cak the inspecta when readyt Date Ready:
VSED CONTRACTOR ❑ COMPANY ❑ OWNER and here6y request inspection of the elechicat work at
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noaaor, company or
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Pl�ae Provide Two (2) P Numbers I
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