P - 79196�-76�-5150
NEW O REMODEL ❑ ADDITION O
?{CEL E
I POWER SUPPLIES
ALARM, COMMUNICATION, REMOTE CONTROI
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
3 to 12 Units (� $50 Per
REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Sa+nt Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
2 Describe -usin the back of the white copy if neCessary - the work covered by this request:
?GY SAYEf�'S SWITCH
Outdoor Liqhtinq StandaN an $1
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1 7 6 8 5 1 5 7
� Transformer / Power Supply for Signs I Outline Lighting @ 55
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$60
Reins tion Fee $20
TOTALFEE
(minimum total fee is $20) 20.$D
T�ns u� Foa iru�craa usE «ar �
I hereby certify that I inspected the electrical insfalla6on described herein on the dffies sta�d:
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Request Date: Rough�n Inspection Required? ❑ Yes Inspection Other Than Rough-In: ❑ y Now � Will Call
���Q� Yai must call the inspeclor when ready! Date Ready:
I certify that I am the �CICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspectlon of ihe elecUical work at::
INSTRUCTONB ON BACK OF YELLOW COPY BOARD OF EIECTRICITV COPY EB-OOOOtA-14 8.1. 2002