P - 78948REQUEST FOR ELECTRICAL INSPECTION
1����- 3 5 0� Minnesota Board of Electricity
1821 University Avenue Suite 5-128, SaiM Paul, Minnesota 55104
' (651)642-08001"TY/MRS 1-800�27-3529 www.electricirystate.mn.us
��IEW ❑ REMODEL ❑ ADDITION 0 REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
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JICES I POWER ;
0 to 400 Ampere @
401 to 800 Ampen
Above B00 Amper
;UIT51 FEEDERS
0 to 200 Amcere @
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
3 to t2 Units � S50 Per Unit
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�6213506
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� certify tlk�t I am the
� Transiormer 1 Power Suppiy fw Signs I Outline Lighting �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Cirouits and Txro Inspection Trips Each Dweliing Unit � S80
TOTAL FEE I %S O� �,
`�'�' �ttiimm m total fee is $20) �.•C
rws uu� Fon rcavECTOa usE orar
I hereby ceitify Mal I i�speded the electric� instaYa6on desaibed hwein on the da�s s�etl:
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�^�" ��aeaaon Rev�r res Inspeclion Other Than RougM�eady niow � wn can
You must caN Mie inspector when r�A De� �y,
NSED CONTRACTOR OCOMPANY t7 OWNER and hereby request a�specfion of tlie el�trical work at:
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