P - 76078REQUEST FOR ELECTRICAL INSPECTION `
2� 0 C� ���� 9 � Minnesota Board of Electricity
� 1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-62 -3529 www.edectrdcity.state.mn.us
Describe -using the bacdc e wh' cap necessary - rk covered uest:
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)MMUNICATION, REMOTE CONTROL, SIGNALING
CIRCURS OF LESS THAN 50 VOLTS
iystem Device or Apparffius Ca� $.50
MULTIFAMILY DU
3 to 12 Unfts
Home
�II I! III II �I II II I I I Ili I I NI I I III II III Q� I�
�[157649Z
Transformers wer 70 KVA $ ZO
Transfomrer / Porover Supply for Signs / Outline Lightir�g @$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Am�res, All
Circuits and Two Inspecti�on Trips Each Dwelfing Unft @$80
fUTALFEE �• �
(minimum total fee is $20) �
TMS Af�A FOR P1SPEtTOp IISE �VI.Y
S°9'� S
I hereby certify tl�at I inspeded ffia el�tricel iretallatlon des¢ibed herefn on ihs datea eteted: I
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N"OR OF�ICE UgE G'FJLY
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��' Rou h-in Ins on
I� •/� `�� g pedl Requi2d? ❑ Yes ❑ No Inspedion Othar Than Rough-In: � Reatly Now V1�0 Cell
You must cell the inspector when readyl Date Ready:
I certify that I am the�LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Site StreetAd -. - �- -_� .' / l �/ CKy . /' /%
�1aV.
Address
� , � �
Mastei Electridan or Power Lim'r
Llcense Number
a Two (2) Phone Numbers Indudirtg �