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P - 781141-5�6-909 � ❑ NEW ❑ REMODEL ❑ ADDITI ❑ �c[` v � ca. L'� f to 800 ALARM, COMMUNICATION, REMOTE CONTROI CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Exh Svstem Device or Moaratus @ 5.50 3to12 REQUEST FOR ELECTRICAL INSPECTION Minnesota Board of Electricity 1821 Universify Avenue Suite S-128, SaiM Paul, Minnesota 55104 (651) 642-0800 TTY/MRS 1-800�27-3529 www.electriciry.state.mn.us � Describe -using fhe back M the white copy 'rf necessary - the work covered by this request Su �lemental Fee E20 Tr�sfomiers u to 70 KVA $10 Transfomiers over 10 KVA 5 20 Tr�sfomier I Power Su for S' ns I Outline L' htin SS ONE & TWO FAMILY DWELLINGS, EACH UNIT includes the Service andlor Power Supply up to 500 Amperes, All Circuits and Two Inspection Trips Each Dwelling Unit @$80 Addition� Inspection Trips � 520 I Investiaative Fee iv�n�rtt c� (minimum total fee is $20) �� / .7 � TMS IAFA FOR MlSPECTOR lbE MY ��ICfCbY C!f/ry � � IIIS�EC� dlB �'IC2� IIISi�3�Ofl �lYXI� �1Cd11011 d1E d�5 �: � � i� �«� a.s, � M�� THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS ----------- �' ,' (�g� I�h�Nlllllllllilllllllllllllillll��l� � � 15969090 ��0 � �: �� Rough�n Inspection Required? ❑ Yes Ins Peclion Olher Than RougMn: Ready Now I Call You must call the inspedor when rpzdy! Date Ready: I certify that I a the ICENSED CONTRACTOR ❑ COIu�ANY ❑ OWNER and heieby request inspection of ihe electrica� wak at;