P - 78391-7 REQUEST FOR ELECTRICAL INSPECTION
1- 4 9 8� 1�� � Minnesota Board of ElecUicity -
1821 University Avenue Suite 5�128, Saint Paul, Minnesota 55104
`' (651) 6; 2-0800 TTY/MRSr'f���27-3529 www.electricirystate.mn.us
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❑ NEW ❑ REMODEL ❑ ADDITION REPAIR , Descri�e -u�the t�,ls e copy if necessary - the work covered by this request:
POWER SUPPLIES
.
ALARM, COMMUNICATION, REMOTE CONTROI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A aratus $.50
ADDITIONS TO THE GENERAL
Retrofit � $.25 per I
�ivot Irtiaation Boom
IIII II III II III II III II III II III II III II (II �� I�
14987374.
Outdoor Lighting Stand
Trafic Sianal Standard
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes ihe Service �dlor Power Supply up to 500 Amperes, All
Circuits and Two Inspecfion Trips Each Dwelling Unit �$BO
Addi6onal Ins tion Tri $20
Investi ative Fee
Reins tion Fee $20
TOTALFEE
(minimum total fee is $20)
T HIS AREA FOR INSPECiOR USE dLV
1 hereby cer6ty that I inspec0ed the electrical i�allafion de.uribed here� on Ihe d�es sfa�d:
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�Q� Rough-in Inspedion Required? ❑ Yes Inspedion Ot an R In: ❑ 1NAI Call
You must call the inspector when ready! Date Ready ,
I ce that I am CENSED CONTRACTOR ❑ COMPANY ❑ OWNER and he y requ t mspection of the electrical work at:
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INS7RUC".ONB ON BACK OF YELLOW
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License Number
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BOARD OF ELECTRICRV CAPY EB-OOOOtA-14 8.7. 2002