P - 75401� RE E���FOR ELECTRICAL INSPECTION
1°���� 2 7 0 � Min esota Board � Elestricity
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
� (651 642-0800 TTY/MRS 1-800-627-3529 www.edectricity.state.mn.us
Descrih�sing the back of the w�ite copy if necessary - the work covered this request: �/�
CIRCUITS OF LESS THAN 50 VOLTS
3 to 12
INSTALLATION MAY BE ORDERED
IIIII�II��IIIIIIIIIIIIIIIIIIIIIIIIUIU��I�
182027�5
Transformers over
Includes the Servfce andlor Prnxer Supply up to 500 Amper�, Atl
Ciraiifs and Two Inspection Trips Each Dwelling Unit @$BO
Additional In on Tri $20
Inv�G ative Fee
Reins 'on F� $20
TOTALFEE ,f
(minimum total fee is $20) / r
�TMSAREAFOAINSPECf0.416E0I�LLY
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� Rough-in Inapection Required? ❑ ras p No Inspedion Other Than Rough-In: ❑ Ready Naw ❑ WiA Call
�� 6��� You must call the inspeaor when readyl Dabs Ready.
I certify tlrat I am the � LICENSED CONTRACTOR ❑ COMPANY�OWNER and hereby r�uest inspection of the electrical vaork at
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ma�er rrecmcaan or
Lir.ense Number
or er re �lauew�.� Plea� Provide Two (2) Phorre Numbers Im�uding Area Code /
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