P - 76534REQUEST FOR ELECTRICAL INSPECTION �`�
I � � $ q, �� v � 8 6 � Minnesota Board of Electricity • ��� � j �j /S �-. :
� 1821 University Avenue Suite S-128, Saint Paul, innesota 5104 �
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state./►n+,us ��>r""
Describe -using th back of t e white copy if ne�essary - the wo�k covered by this request:
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� Above 800 Ampere @ $75
C U IFEEDERS
to 200 Am ere a$5
Above 200 Am ere $10
LARM, COMMUNICATION, REMOTE CONTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL F
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Additional Unit an $25
i Home Park
Vehicle Park
Standard
Transformers over 10 KVA $ 20
' Transformer / Power Supply for Signs I Outline Liqhtinq $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additional Inspection Trips @ $20
� Investiqative Fee
TOTALFEE
(minimum total fee is $20) , �
THISPREAfOftINSPECTqjUS L`
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I hereb ceN that I in ded the ele L� `�� 9'`�' �"�,�
y fy spe cMafinstallation described herein o
iOUGHIN DATE
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ecial Inspeeti�on @$.31 per Mile I �
INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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18435867
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Rough-in Inspection Required? es - Inspection Other Than Rough-In: ❑ Ready No
You must call the inspectar when ready! Date Ready:
I certify that I am e LICE ED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
JobSite treetAdd �/ ^'� ��� `. C� ♦ ��
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wns Section Range Fire No. Count !� _
1�i�R ELEC ► K��, ����
577 SHOREVIEW PARK ROAD
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nse N Master Electrician or Power Limited Technician
License Number
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P��� � ers Induding Area G
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� FR11MI111 e_�c