P - 75523�` ^ REQUEST FOR ELECTRICAL INSPECTION y��`
1 � ��"r � � � 41 � � Minnesota Board of Electricity 5 , `
1821 University Avenue Suite S-128, Saint Paul, Minn�ota 55104
r (651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
Descdbe -us " back of the whfte copy'rf nec�ssary ' vrork avered by this rec�{est:
Standard
CIR S/ FEEDERS " Transfortner I Poa�rer Su 1 for S' r�s / Outline Li $5
0 W 200 Am re$5 ONE 8 TVNO FAMILY DWELLINGS, EACH UNR
Above 200 Am re $10 Includes the Service andlor Power Supply up to 500 Amperes, All
AIARM, COMMUNICATION, REMOTE CONTROL, SIGNALIN Cira�ts artd Two Irrcpectlon Trips Each Dwellmg Unit @$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS AddiUonal InsoecUon Trios C�a. $20
3 ro 12 units @$50 Per Und (minimum total fee is $20)
Each Addrfiomal Unlf (oj $25 '�^"E"`��f0R0
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OTHERADDITIONALFEES M�/• �G—d a—'
UpMing Retrofit C�D $.25 per Fature I herebvi certifylhat I Inspeded ihe electriml insmlia8on
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ATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS �
F'JP, t7FFICE USE t7NLY
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�� Rough-in Inspedion R uired? �es ❑ No I
/��� � nspectlon Other Than Rough-In: 0 Ready Now �WiO Cell
IYou must call the inspector when ready! Date Ready.
I certliy that I am the ❑ LICEWSED CONTRACTOR ❑ COMPANI' � OWNER and hereby request inspection of the electrical work at
Job Site Street Addresg Cttv
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I Contractor /
or
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M�ter Electrician or Power Limfted Techr
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le Two (2) Phorre Numbera Indud(ng Area Cod�
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