P - 76118REQUEST FOR ELECTRICAL INSPECTION
1� 7 8 7� O 8 7 � Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
'' (651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
D�e -�ing the back of the white copy if ne���ne ����,ny����sr � SW T i"CH
11YWAUFVICATION, REMOTE CONTROL, SIGNALING
CIRCUITS OF LESS THAN 50 VOLTS
Boom
Outdoor Linhtina Standard
Transformers u to 10 KVA $10
Transfortners over 10 KVA @$ 20
Transformer I Power Supply for Signs / OuUine Li htlng $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuit5 and Two Inspection Trips Each Dwelling Unit @$80
TOTALFEE
total fee is $201
fhe elec6ical instaVafion describetl herein on Ne da0es stated:
-�f�' .� 6 I
Ti#fS Il�$TALLATIO(N MAY BE ORDERED DISCONNECTED_IF NOT COMPLETED WITHIN 12_MONTHS ________
1 N� �I II! II �i� Ii �{ II �I II III II I� II I� II III I IIII
- _ :�--.,1 7 .8. _7 D $ 7 4
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D�� Rough-in Inspection Required7 ❑Ye �] No Inspection Other Than Rough-In: [�2eady Now �WIII Call
$I �. �%06 You must call the inspector when readyl Date Ready:
I certify that I am tfte � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
R0$TRUCTION$ QN 86CK OF YELLOW COPY BOAR� OF ELECTRICITV COPV ca_mmm e.t o. rn.n.