P - 75403REQUEST FOR ELECTRICAL INSPECTION � �`
1����- 4� 4� Minnesota Board of Elsctricity
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-500-627-3529 www.electricity.state.mn.us
Describe -using the baa�:uf the white co 'rf necessary - the covered this requ •
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GENERAL FEES Outdoor LigMing Stantlard @$1
S�RVICES / POWER SUPPLIES Trsiffic Sianal Standard nn R5
;UITS, CIRCUITS OF LESS TNAN 50 VOLTS
Each Svstem Device or Aooaratus (o� �.50
unit @
Center
IIdSTALLATION MAY BE ORDERED D
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182�4248
� Transformer / Power Supply for Signs / OuUine Lightin Q$5
ONE & TWO FAMILY DWEWNGS, EACH UNR
Includes fhe Service andlor Power Supply up to 500 Am{�res, All
Ciraiits and Two Inspectlon Trips Each Dweuing Unit @$80
Additional Inspectlon Tdps @ $20
InvesdgaUve Fee
Reinspection Fee Q $20
. TOTALFEE �1�
(minimum total fee is $20) �(J a �
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I hereby certlfy that I 6�d 6m electrical i�telladon d�bed herein on tlre dates at�
Ra,m, u, � p��
Fu+aimsrECnoN �v pp�
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) fF NOT COMPLETED WITHIN 12 MO H
FQF 6FF1','E USE ONLY
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Rough-in Inspectton Required9 �+fes ❑ No Inspectlon Other Than Rough-In: ❑ Ready Now ($�NW Call
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You must call the insp�tor when readyl Date Ready.
I certiiy that I am the 0 LICENSED CONTRACTOR ❑ COMPANY OWNER ami hereby r�uest ins�tion of the electrical work at
Job Site Street Address `� �
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urany
or
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r�se Number Master Electridan or Powar Limited TechNc
Licenae Number
Please Provide Two (2) Phone NumbeB Including Area Code
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