P - 79327❑ REQUEST FOR ELECTRICAL INSPECTION
�� 1� J- 5 9 4 5 Minnesota Board of Electricity
1827 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electncitystate.mn.us
NEW ❑ REMODEL ❑ ADDITION 0 REPAIR Describe -using the back of the white copy if necessary - the work covered by this request.
�C�L ENE�:GY SAd'E�"S SW!"fCr�
GENERAL FEES Outdoor Liahtin9 Siandard (� $1
SERVICES! POWER SUPPLIES
ALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aona�atus (� 5,54
Each Additional Unit
ADDITIONAL
1 l� � lii li i� 11�� 1141i ll III II�11111 �I II H{ Ni��
17735945
� Transformer! Power Supply for Siqns ! Outline Lighting �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two InspecGon Trips Each Dwelling Unit @$80
TOTALFEE
(minimum total fee is $20) �20.�4
iM15 AREA FIXt INSPECiOF USE OPIv
I hereby certlty Ihat I inspected fhe electrical installa6on described herein a� the dates st�ed:
Q .�� �- o
� 5a'71
� �b
Request Date: Rough-in Mspection Required? ❑ Yes �'1Vo I tnspeciion Other Than Rough-In: L7f&ady Now U VYNI Caif
�g(2�iaQ You must caft the inspectw wAen ready! Date Ready.
I certify that I am the C�ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and her�eby request inspection of tlie elecUical work ar:
INSTRUCTONS ON BACK OF YELLOW COPY BOARD OF ELECTRICITV CAPV E8-OOOOlA-14 8.1. 2002