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REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.edectrfcfty.state.mn.us
� e work covered 4 th�re�e—st. /� /��(/ U C`'
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Outdoor Liahtina Standard a(Z $1
)MMUNICATION, REMOTE CONTROL, SIGNALING
CIRCURS OF LESS THAN 50 VOLTS
3 to 12 Unik
Manufacture.d Home
up to 10 KVA
overl0 KVA
ONE & TWO FAMILY DWEWNGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Txro InspecUon Trips Each DwaWr�g Unit @$80
Add(tional Ins 'on Tri $20
Investigative Fee
Reins on Fee $20
TOTALFEE
(minimum total f� is $20) �
nus ar�n Fat wsvEm� usE mar
I hereby certify that I i�peded fhs elecfiical h�ellatian desaibed herein an the da�es s�ted:
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�OR O=F:CE USE �dLt
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I�� Rough-in InspecUon RequhedT ❑ Yes �Vo InspecUon Other Than Reugh-In: ❑ Ready Now�W01 CaA
$ I� You must call the I�pector when readyl Date Ready.
I certify that I am the� LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby r�uest inspection af the electrical wark at