P - 75865REQUEST FOR ELECTRICAL INSPECTION �' � L,.
� � � � � � 4, � � � Minnesota Board of Electricity � �
1 8 2 1 U n i v e rs i ty A v e n u e S u i t e S- 1 2 8, S a i n t P a u l, M i n n e s o t a 5 5 1 0 4
(651) 642-0800 TTY/MRS 1-800-627-3529 www.edectriciry.state.mn.us
Desaibe -usir�g the back o hite copy'rf necessary - the work core��' y ►'is request:
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/ POWER SUPPLIES
0 to 200 Am $5 �
Above Z00 Am�re �$10
tM, COMMUNICATION, REMOTE CONTROL, SIGNALING -
;UITS. CIRCUffS OF LESS THAN 50 VOLTS
12 Units (m $50 Per Unit
Manufactured
S�eaal I� edion @$30 per Hour
S " Ins on @ $.31 �r Mile
THIS INSTALLATION MAY BE ORDERED I
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1118�I�ili�i��i�lllll�l��lllll�l��l�
18204552
Transfarmers over 10 KVA $ 20 ° `
Transformer / Power Supply for Signs / Outline Lighting @$5
ONE & TWO FAMILY DWEW NGS, EACH UNIT
Includes the Servic;e and/or Power Supply up to 500 Amperes, Atl
Circuits and Tvro Inspec,fion Trips Each Dwellmg Unit @$BO
TOTALFEE
total fee is $20)
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I hereby certHy tlret I Inspected the el�ricel
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de�ed here(n on the dates steted:
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) IF NOT COMPLETED dYITHIN 12
FpP.OFPICE USE (}NLY
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�� Rough-in Inspecdon Required? �Yes ❑ No Inspectian Otlrer Then Rough-In: ❑ Ready Now CaA
'� (,�' V� You must call the inspedor when ready! Date Ready.
I certify that I am the � LICENSED CONTRACTOR ❑ COMPANY
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ompany Name
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Ignature �trac o er Pertor
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and hereby request inspecfion of the electrical work at
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Flre No. Couniy
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PIe� Provkle Two (2) Phone Numbers Including Area Code
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ise Number Master Electrician or Power Lim(ted Technicien
Ucense Numbar
Pleasa Provlde Two (2) Phorre N�nnbers Inciuding Area Code
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