P - 79220REQUEST FOR ELECTRICAL INSPECTION
� -� � � Q � � /� � � Minnesota Board of Electricity �
, V `� 1821 University Avenue Suite S-128, Saint Paul, Mi�nesota 551�4
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
NEW O REMODEL ❑ ADDITIpNE�OREP�IL2�pesc�be; ySlllQthe b��gy✓,hite copy if necessary - the work covered by this request:
XC Eftif R Y AVtf"{ a � [rl••I
GENERAL
n
ALARM, COMMUNICATION, REMOTE GONTROL
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
ADDITIONS TO THE GENERAL FEES
WELLINGS (PER UNIT)
> C� S50 Per Unit
i l�l ll I� � I� II II( Il Ill �� Il III II �I � I� I�I
176a5462
j Transformer / Power Supply for Signs / OuUine LighGng @$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 50� Amperes, All
Circuits and Two Inspection Trips Each Dwelliag U�it @$80
(minimum total fee is S20) � 20.50
- THIS AREA FOR INSPECIOR USE ONLY
I here6y certify that I inspected the electrical inst�lation described I�erein on the dates sbted:
R 469�
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Request Date: Rough-in Inspection Required? ❑ Ves f� Inspediai Other Than Rough-In: ❑ eady Now O Vlrll Call
d��fl� You must call tlie inspector when ready! Oate Ready.
I certify that I am the C7�IifCENSED CONTRACTOR J COMPANY ❑ OWNER and hereby request inspection of the elecUical wo�C at:
INSTRUCTONS ON BACK OF YELLOW COPY BOARp OF EIECTRICITV CAPV EB-00001A-14 8.1. 2W2