P - 760281�-787-060 1❑
�PY
��
CIRCUITS OF LESS THAN 50 VOLTS
iystem Device or Apparatus (m $.50
�spection @ $.37 per Mile
'ALLATION MAY I
REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricdty.state.mn.us
� t�he'�,f�by�i��t' S SW I i'LH
Outdoor Lighbng Standard
Transformers over 10 KVA a$ 20
Transfortner I Power Su I for Si ns / Outline LI htln $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Cirouits and Two Inspection Trips Each Dwelling Unft @$80
Addi�onal Ins 'on Tri $20
Inves6gative Fee
Reinspection Fee $20
TOTALFEE s o.
(minimum total fee is $20)
THIS AREA FOR PlSPECTOP USE ONLY
I hereby certfy that I inspected the electrical instellation described herein on tl�e dat�
IF
IIIII III� ��! B!� II�I II�I IINI ��I �II1 I�II
��� � ����
L7s�o6n1
�Z� �
12.MONTHS
��� Rough-in Inspection Required? ❑ Ye� �] No Inspectlon Other Than Rough-In: [xReady Now 0 Will Cail
$i ��lQ� You must call the inspector when readyl Date Ready:
I c�rtlfy tliaf I am the L�I LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at