P - 762751���5 3 5� �EQI�EST FOR ELECTRICAL INSPECTION
� � Minnesota Board of•Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
' . (`651) 642-0800 TTY/MRS 1-800-627-3529 www.elecJricity.sJate.mn.us
'-usin� tlie back of the white copy 'rf necessary - the work covered by this request:
_ - E;:CEL E{�E�iGY ��i�JE�i'S SWITCH
GENERAL FEES Outdoor Liahtina Standard CD $1
Transformers up to 70 KVA @$10
Transfortners over 10 KVA C� $ 20
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unft @$BO
I CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
TO THE GENERAL FEES I I Reinspection Fee
Lots
Vehicte
TOTAL FEE �v �
total fee is $20)
I hereby cer6fy that I inspected the electrical installatlon described herein on the dates stated:
TH�$ INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 I
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�e� Rough-in Inspection Required7 ❑Yes .❑No Inspection OtherThan Rough-In: �Ready Now ❑Will Call
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�j/ j� �, j�l J—' You must call the inspector whan readyl Date Ready:
f certity that I am the �1 LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job SKe Street Address City
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Trnmnship Section Range Fire No. Cou
Owner/Ocxupant Name Please Provide Two (2) Phone Numbere Including Area Code
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ElecVicel Utility Electrical Udlity Address
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CoMrector / Company Name Contractor License Number Mester Electrician ar Poxrer Limfted Technician
License Number
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M�iGng Address (CanVactar, Company or Owner Performing InsffiIlaSon)
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Authorized Sig�mtuura (Contractor or Owner Performing Installatlon) Please Provide Two (2) Phone Numbers Including Area Code
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