P - 759411 REQUEST FOR ELECTRICAL INSPECTION
2� 01 �� 6 9 9� Minnesota Board of Electricity
C �� 1821 University Avenue Suite 5-928, Saint Paul, Minnesota 55104
(651) 642-0800 T'fY/MRS 1-800-627-3529 www.electrlcaty.state.mn.us
Descri ing th�ok m white copy'rf necessary - the work covered by this request:
� �� r� (o� ( - �� pAl ��"S
Fee
401 to 800
Above 200 Am re $10 Includes the Service and/or Pmaer Suppry up to 500 Amperes, All
tM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Tdps Each Dwelling Unit @$80
UITS, CIRCUITS OF LESS THAN 50 VOLTS Additlonal Ins 'on Tri $20
Each S em Device or A s@$.50 Invesd ' e Fee
ADDITIONS TO THE GENERAL FEES Reins 'on Fee $ZO
fIFAMILY DWELLINGS PER UN TOTAL FEE v�/y
3 to 12 UniGs @$50 Per Unit (minimum total fee is $20) o�-v
I hereby certHy that I Uuspected tlre electrical I�taVatlon descrl6ed herain on the dafes
�I Vehicle Park Sit� $5 �TM"� °''�w" j °ATE
ondin Ins 'on $20 �'—��
�ection @ $30 �r Hour °�D/ °A1E
�ectlon $.31 r M1e
iLLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLE'i'ED WITHIN 12 MONTHS
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You must call the inspector when readyl Date Ready.
I certiffy that I am the�l ICENSED CONTRACTQR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical wark at
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