P - 79339REQUEST FOR ELECTRICAL INSPECTION -
�����- 6 0 7� Minnesota Board of Electricity �
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us
❑ REMODEL ❑
/POWER
TION ❑ REPAIR Describe -using the back of the white copy if necessary - the work covered by this request.
XGE� EPIERGY SAVER'� SWITCH
tai FFFS Outdoor Liohtino Standard Ca1$1
ALARM, COMMUNlCATION, REMOTE CONTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL F
Each
Retrofii
Boom
i IiH il ll! II � Il l�f 11111 II HI II �i I I���I 11{il
17736ti75
1Q
f Transfortner / Power Supply for Siqns / OuUine LighUng (,N $b
ONE & TWO FAMILY DWELLINGS, EACH UNIT
fncVudes the Service andior Power Supply up to 500 Amperes, NI
Circuits and Two I�spectio� Tdps Each Dwelling Unit �1$80
(minimum total fee is $20) � �2U.5U
- iH15 AREA �OR N6PE�i0R �5E «�..
I hereby certify Mffi I inspected the electrical insW lation destribed herein on Me date5 Sta�d:
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Request Date: Rough-in Inspection Required? Yes ❑ Insped'an Other Than Rough-In: ❑ y Now � Will Call
���%� You must call the inspedw when ready! Date Ready.
I ceAify that I am tt�e �ICENSED CONTRACTOR ❑ COMPANY D OWNER and hereby request inspection of ttie electrical work at:
INSiRUCTONS ON BACK OF YELLOW COPY eoaxo oF �crnicm coPr E&OOO�tM14 e.�. zoo2