P - 76015REQUEST FOR ELECTRICAL INSPECTION
�� 5 7 3�� 0� � Minn�ota Board of Electric6ty
1821 University Avenue Suite S-128, Sairrt PaW, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.elecbicity.state.mn.us
� NEW ❑ REM�[3EL'�O ADDR/IO�N O REPAIR Desaibe -using the ba�ck the xrhite copy 'rf n - the rrork crove by this request:
O�Q/ '�a �tvl� 'TFa f��v'dCo A 4 s� U� �Ll G�,. ��J-�C
)MMUNICATION, REMOTE CONTROL
CIRCUITS OF LESS THAN 50 VOLTS
ADDITIONS TO THE
FAMILY DWELLINGS (PER UP
to 12 Units @$50 Per Unit
�h Addi�onat Unit @ $25
Prvoi
��� ��� ��� ���� ���� �������� ����� �� ��
15739071 �
Transformers u to 10 KVA $10
Transformers aver 10 KVA @$ 20
Transformer / Power Supply for Sip� / Outlirre Lighting $5
ONE � TWO FAMILY DWELUNGS, EACH UNIT
Includ� the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips E�h Dwelling Unit @$80
��in�rrL •.ZR�, ✓ `°"
(minimum total fee is $20) ,Jcs��
TMSNflENFQtPSPECfORISEp�p,Y '
� Ii@�Bby CCIS(y H18i � I�S�d il� P.I�h1Gal II6�011 dESCdI� IICICRI OII t1i8 � Sl21@d:
�lo� �
- ------ �
: �� ,�,_ ��.
� �'�'�� � C�C �
� C�
K�ues� uare: aouBn-in ins�on iteyu�r�z ❑ r� �o �nspecenn o►r�r n�, �n-m: �rteaey n��n can
�� ��� You musl cell the inspector when ready! Date Ready.
I cerUfy that I am ihe �JJCENSED CONTRP,CTOR ❑ COMPANY ❑ OWNER and hereby request mspection of the electrical work at: