P - 76349REQUEST FOR ELECTRICAL INSPECTION �
� � � �� � � 3 � � Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricety.state.mn.us
Describe -using the back of the white copy'rf nec�ssary - ths work corered by this ue.st: �
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I SERVICES / POWER SUPPLIES
0 to 200 Am ere a$5
Above Z00 Am ere $10
ALARM, COMMUNICATION, REMOTE CONTROI
CIRCUITS, CIRCURS OF LESS THAN 50 VOLTS
Each Addi�omal Unit
ORDERED
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19?96317
ONE & T1N0 FAMILY DWELLINGS, EACH UNIT
Indudes the Service andlor Pomrer Supply up to 500 Amperes, A�
Circuits and Tvro Insp�tion Trips Each Dwelling Unft @$80
Addfional Ins 'on Tri $20
Irnestigative Fee
Reinspecfion F� $20
TOTALFEE
(minimum total fee is $20) ��,��
TMS FI�A F67 PiSPECTOR ll� ONLY
d fieteim ce[Mv Umt I f�ed fhe eleckical Uis�ar d�sa�ed here6ton fdeda�s st�d:.
REC'D NPA�"�-���"'ZOO7
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�8� Rough-in Insp�tlon Raquired? ❑ Yes �No Inspectian Other Than Roughdn: � Ready Now�llt� Cell
,�'a �� You must call the inspedor when readyl Date Ready.
I ceitify that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY � OWNER and hereby request inspecfion of the ele,ch�ical work at
Name =.:: _ _ . Gor�actor6lcense Numbec .. . :
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