P - 76358REQUEST FOR ELECTRICAL INSPECTION � �'
'� �� O 2�� 4� 7 � Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-500-627-3529 www.edechicity.state.mn.us
Describe -usi �,�� the wI�oPY�� ithe work covered this u. C�/�� l�0
!/� J �G � --1
0 to 400 Ampere $25 Supplemerital Fee �$20 :� 1
401 to 8�0 Am re $50 Transfomrers u to 10 KVA $10 .$
Above 800 Am re$75 Transformers over 10 KVA $ 20
:UITS / FEEDERS Transformer / Power Su I for Si ns / Outlin ' htin $5
0 to 20{I Am re$5 �— ONE 8 NUO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re$10 Includes tl�e Service and/or Power Supply up to 5Q0 Am�res, All
ann cnannnuNirannm aFnnn� rnnmarn sir,aai wr, Circuits and Two I�oection Trios Each Dwellina Unft Ca� �8
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Devfce or Apparatus Q$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS (PER UNITI
Manufacdued Home Park Lots
�THIS IPISTI�LLATION MAY BE ORDERED C
��I� �� �� � I�I f� �u �� �I� �� ��� �� I� a In �� ��
18204578
total fee is $20) , � (,
1FLLS PREA FOR PSPECTOA 16E INLLY
��- �a�-G7
d the electriml insfallaHon desaf6ed hdrefn on fhe dates atated:
I/'�---- �` O�' I�/ 1%�`�� Q%
FOR OF�ICE USE OidL'f a) `-
����- �1� �
�� Rough-in Inspectlon Required? ❑ Yes ❑ No Inspectton Other Than Rough-In: ❑ Ready Now ❑Wi0 Ce0
��' 4�z`�—��
You must call the inspector when readyi Date Ready.
I certify that I am the � LICENSED COM'R/�CTOR ❑ COMPANY OWNER and hereby request inspection oFthe electrical work at
Job Site SUeet Addr�s Ciry
l �� l��r� �'�' ��.Y `G! � ,�,�f�a ��
� � � ��
�,
3
. ComPanY or �
dar or C�oi
�
---�--� ---����a� ��-
Please Provhle Two (2) Phorre Numbeis Ini
� � � �
mas[er tiecmaan or
Li�nse Niunber
��j'd�'2o �d i���°7�'`�crG��.
ca_mmme_�s v � rmn