P - 76206q REQUESI' FOR ELECTRICAL I P "'
�� 15 � 0114, � Minnesota Board ctricity f—�� ���
�� = 1821 University ' S-128, Sainf Paul, �Ainnesota 51�04
(651) 642-08 -800-627-3529 www.electricity.state.mn.vs
D�cribe -using the bacN�of the white copy'rf ner�ssary - the work vered by requ t: ,
I SERVICES / POWER SUPPLIES
0 to 200 Am ere $5
Above 200 Am ere c�10
ALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S em Device or Apparatus $.50
ADDITIONS TO THE GENERAL I
MULTIFAMILY DWELLINGS ER UN
3 to 12 Units CaD $50 Per Unit
Standard
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includ� the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Insp�on Tdps Each DwelGng Unit @$80
total fee is
I herehv ceAHV that � inspected me elecMcal i�taueuon desaibed here6i on ure dams smt�: I
ManuFadured Home Park Lots $25
Recreatianal Vehicle Padc Sites $5 F°''"` �`�"°" _%T�
Se BorM' Ins 'on $20 �—�r � G
S Ir6 on $30 r Hour °�'"�ONm °ATE
Special I� on @$.31 r Mile
S INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COAAPLETED YYITHIN 12 MONTHS
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I�IIIIUIIII�I��III�IIIIIIII�III��II�I�I� I�� �UN 2"9 2007
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I certify that I am the C
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Rough-in Inspection Required? ❑ Yea o Inspectlon Other Then Rough-In: � Ready Now ill Cell
7
You must call the inspedor when readyl Dete Ready.
VSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspe.ction of the electrical work at
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M�ador Licer�se Nwnber MasDsr Electridan or P
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Please Provide Two (2) Phone Numbers
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