P - 76348REQUEST FOR ELECTRICAL INSPECTION / . "'
� �s� � � � o � � � Minnesota Board of Electricity ��/
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.edectricity.state.mn.us • � "'�
D�cribe -using the back of the white copy'rf necessary - the vaork covered by this requ�st:
0 to 400
Above 200 Am ere (a�$10
ALARM, COMMUNIGATION, REMOTE CONTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Addfional Unit @
Retrofit Ca? $.25 aer Focture
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�,9610609
Fee
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two InspecUon Trips Each Dwelling Unit @$80
Additional Ir�s on Tri $20 ,(
Inv�ti ative F�
Reins 'on F� $20
TOTALFEE
(minimum total fee is $20) . ��
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I he[eby certify fhat I inspected tlre el�ical tr�0atlon de�ed Irerefi on 5re dat� st�l:
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��� Rough-in Inspectlon Required?,�Yea ❑ No InspacHon Other Tfien Rough-In: ❑ Ready Now �Jfll Cap
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a You must call the inspector when readyl Date Ready.
I cefify that I am the�LICENSED CONTRACTOR ❑ COMPANY 0 OWNER and hereby request inspection of the electrical.work at
Job S�e Street Address C(ty
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Mailing Address (CoMractor, Company or Owner Perl
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:orrtractor License Number Master-Electridan or Power LimFted Technid�
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Please Provide Two (2) Phorte Numbera Irtcluding Area Code
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