P - 760611 7 8 7 0 9 3� REQUEST FOR ELECTRICAL INSPECTION
s � 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.sfate.mn.us
DesCri�e -�sing the back of the white copy'rf ne�� t�he ���by�ii��t; 5�� ��C�
,
SUPPLIES
IMMUNICATION, REMOTE CONIROL, SIGNALING
CIRCUITS OF LESS THAN 50 VOLTS
i�tem Device or Apparatus na. $.50
� Transfortner I Power Supply for Signs / Outline Lightlng @$5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspecbon Trips Each Dwelling Unit @$80
Addfional Insoection Trios C� $20
TOTALFEE
total fee is $201
electrical instellatlon described herein on the dat� s�ted:
� /'�—B G
Tt�!(f1�TALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS __ ___�
- �i�����E�iiir�.ii��i�ii�i�iiiiiiiii�i
17870932
������-�c�
��� Rough-in Inspection Required? ❑Ye �No Inspection OtherThan Rough-In: �Ready Now ❑Will Cell
�� �. 4�06 You must call ihe inspector when readyl Date Ready:
I�rtify that I am the L� LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electricxl work at