P - 76045❑ REQUEST FOR ELECTRICAL INSPECTION
1����- 0 6 3 5 Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electr�icity.sdale.mn.us
Dttscribe -using the back o�;he white copy'rf ne���ne �� �d�ny�i��t, ��� � TCH
�
fMMUP1ICATION, REMOTE CONTROL, SIGNALING
CIRCUITS OF LESS THAN 50 VOLTS
ivstem Device 6r Apparatus (a� $.50
MAY BE
I �II II ul �I�� IFHI U� II �� � lu I� ul � IIi I ull
ti���n63s
Outdoor Liqhbnq Standard
Transformers u to 10 KVA $10
Transformers over 10 KVA @$ 20
Transformer I Power Supply for Signs I Outline Lightln @$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Suppiy up to 500 Amperes, All
Circuits and Two Inspection Trips Each Drrelling Un(t @$80
TOTALFEE a:Ve
total fee is $201
�.��� 2
'%t��,�,'�; `:
��- ��>j�-.
��..;:,;
that I inspected the el�tipl ins[allation describetl hereln on the detes
—� �-0g
12 MONTHS
�oc�� ��� ��
��' Rough-in Inspection Required7 ❑ Ye �] No Inspection Other Than Rough-In: [�eady Now 0 WIII Call
$' �' �f �� You must call the inspector when readyl Date Ready:
I c�rkily that I am the L�1 LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
tRF9TR11CTIONB QN BACK �F YELLOW COPY BOARD OF ELECTRICITV COPV FRfIl1(if11 A_t5 n��rme