P - 772271-680-940 �
❑ NEW ❑ REMODEL ❑ ADDITION �
SERVICES I POWER SUPPLIES
0 to 400 Amcere (01 S25
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
3 to 12 Units @$50 Per Unit
Exh Addi6onal Unit � $25
Center
� Special Inspection @ E.31 per Mile
THIS INSTALLATION MAY BE
IIII II III II III II III II III II III II IIl II III �� I IIII
168�9402
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- electricity.state.mn.us
3, Describe -using the back of the white c - the work covered by this request:
;,l,Y v� o.0 � �"
Outdoor Li h Standard $1
Traffic Sianal Standard (� $5
Su demental Fee $20
Transfortners u to 10 KVA $10
Transformers over 10 KVA $ 20
Transformer I Power Su I for Si ns I Outline Li htin $5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspec6on Trips Each Dwelling Unit �$80
Additional Inspec6on Trips @ $20
Investiaative Fee
i�in�rtt L�
(minimum total fee is $20) � J
iH15 AREA Fdt N15PECTd2 USE MY
I hereby cerGy tlwt I inspec0ed the electrical installation described herein on the dates stffied:
IF
12
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-/7 e�l
ReQuest Date: Rough-in Inspettion Required? ❑ Yes � Inspedion Other Tha Rough-In: `�I�eady Now' � Will Call
� a� "� You musl call the inspector when ready! Date Ready: ��� —� �
� �
I certify that I am the. '�210ENSED CONTRACTOR �OMPANY ❑ OWNER and hereby request inspec�on of the electrical work at::