P - 76179REQUEST FOR ELECTRICAL INSPECTION
1� 9 3 3- 2 5 6� Minnesota Board 0f Electncity f
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
s
(651) 642-OS00 TTY/MRS 1-800-627-3529 www.edectricity.state.mn.us
Descnbe -using fl� back of fh�whitgcopy'rf necessary - the work covered by this request:
ALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or AuDaraWs C� $.50
Each Additional Unit @
Boom
ALLATION MAY BE ORDERED
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19332568
Traffic
Transfortners u to 10 KVA $10
Transfortners over 10 KVA @$ 20
Transformer I Power Supply for Signs / Outline Lightlng @$5
ONE 8 TWO FAMILY DWELLINGS, EACH UNR
Includes the Service a�lor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwe�ing Unit @$80
Addfional InspecUon Trips @ $20
Inv�qative Fee
I herebY �Y that I
TOTAL FEE ��
total fee is $20) � e
7FOSqREAFOR WSPECfOR USE WLLY
� the elecMCal In�talla�nn�aeseri6edherefn on tlie ���
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COMPLETED WITHIId 12
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���� Rough-in Inspectlon Requiredl �les ❑ No Inspecdon Other'fhart Rough-In: ❑ Ready Now [�i�CeO
�^�� � 0 6 You must call the inspector when readyl Date Ready.
I certify that I am the �ENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request insp�tion of the electriral work at
.bb Si[e Street Address �ftY
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Address (Contrador. Com�anv or
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Contracror License Number Master Eledrician or P
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Please Provlde Two ) Phone Numbers Including Cade
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