P - 77018REQUEST FOR ELECTRIC INSPECTION
1� 6 41 ° 114 � Minnesota Board of Electricity ��—.- ����SC
1821 University Avenue Suite 5-128, Saint Pa�, Minnesota 55704
(651) 642-0800 TTY/MRS 1-800�27-3529 www.electriciry.state.mn.us
❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy'rf necessazy - the work covered by this request:
0 to 400 Ai
401 to 600
CIRCUITS I
0 to 20
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aooaratus �$.50
OTHER
Retrofit (o� E.25 0
(I��I I) II) IIIII II III �I III II III II III II III �� I�
L6411142
Tra�ic Sign� Standard
Suoolemental Fee � $
Includes ihe Service andlor Power Supply up to 500 Amperes, All
Cireuits and Two Inspection Trips Exh Dwetling Unit @ EBO
Fee
TOTAL FEE I �jJ �
(minimum total fee is $20) �Q
,MIS AREA FOR �I%PE�,OR USE «..Y
I hereby ceAify that I ir�spected the electrical inshapation destribed herein on the dates sf�ed:
IF
'�'�`--� �I"
rcequest ue[e: Rpugh�n Inspection Required7 ❑ Yes �No Inspedion Oth� Than Rough-In: �Ready Now ❑ Will Call
����-�� You must call tlie inspecta when ready! Date Ready.
i certify that I am the � LICENSED CONTRACTOR ❑ COA�ANY ❑ OWWER and hereby request inspection of 1he ek:ctrical worlc at: