P - 75755REQUEST FOR ELECTRIC L INSPECTION ��'_
1�a�`0 - 4 41 0 ��nnesota Board of Electricity �oJ�^ ��07�
1821 University Avenue Suite S-128, Saint Paul, Minnesota 551��
� � � p� (651) 642-08001TY/MRS 1-800-627-3529 www.electricity.state.mn.us �"' "�
D usmg the f�ck of the whfte copy if necessary - th rk covered by this
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aro�e soo am�� � $�s
:UITS / FEEDERS
0 to 200 Ampere @ $5
Above 200 Ampere @$10
tM, COMMUNICATION, REMOTE CONTROL
UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL I
3to12
Park
INSTALLATION-MAY BE ORDERED I
IIIN III� IIIII II�I �III �III �Ifl al� n� I�
19024413
I rransrormers over to KvA @$ zo
� Transfortner / Power Supply for Signs ! Outline Li h8 $5
ONE & TWO FAMILY DWELLINGS, EACH UNR
Includes the Service and/or Pawer Supply up to 500 Amper�, All
Circuits and Two Inspection Trips Each Dwelling Unit @$60
Fee @ $20
TOTAI
iimum total fee is
I hereby certiry Umt I(nspected the eiectricel InstaOaflan desaibed herein un the dafes s�ted: �
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IF IVOT COMPLETED WITHIN 72 MONTHS
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�' Rough-in ins�ctlon R�uir�7 ❑Yes No Inspec4lon Other Than Rough-In: Ready N ���
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You must call the inspedw when read Date Ready.
I certify that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OIMNER artd hereby request inspection of the electrical work at
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�I Utllily Address
' Co cense Number Master Electricfan or Power Limited Techniaan
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al on) , lea� ro e Two (2) P orre Numbers Including Area Code
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