P - 75700REQUEST FOR ELECTRICAL INSPECTION `'
�� 8� �`� �� � Minnesota Bo�rd� of Ele�tricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-OS00 TTY/MRS 1-800-627-3529 www.electriciry.state.mnus
Describe -usir�g the back of the wh,�py'rf n - the work eovered by j is request: �� �
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GENERAL FEES Outdoor Lighting Standard @$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard $5
0 to 400 Ampere (�a. $ Supplemerital Fee @$20
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CIRCUITS OF LESS THAN 50 VOLTS
.Y
Manufactur�i Home Perk LoLs
ONE & TWO FAMILY DVdELLINGS, EACH UNIT
Indudes tha Service andlor Power Supply up to 500 Amperes, All
Circuits and Tvro Inspection Trips Each DweOing Unit @$80
totai fee is
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I Utspeded tlre elec4ipl Nstalla8on descn'bed herein on fhe dates stefed:
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Special Ir�spection Q$.31 per Mite : ,;,
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THIS INSTALLATION MAY BE ORDEREb DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
rOR OFf AC� USE ONLv
��Ill ��l ����l��l����l� ���1� l�ul�l�l� �� �� REC'D MAY 2 9 2007 .
18202796 �
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��� Rough-in Inspectlon Requiredl ❑ Yes ❑ No Inspection Other Than Rough-In: [] Ready Now � Wi0 Catl
y Yau must call the inspsctor when readyl Dete Ready:
I certlfy that I am the ❑ LICENSED COIVTRACiOR ❑ COMPANY - OWNER and hereby request inspeetion of the electrical �tork at
Job Site Street Addr� CRy QT
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ovmahip Section Range Flre No. County .'
Owner/Occupant Name _ PI� Provide Tam (2) Phorte Idumbers Induding Area Code
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Contra r/ pany Name � �� �� Corrtiador Licensa i�lumi�r LIM�� Number or Lim
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Mailing dress (CoMredor, y or Oxmer Pertotmtn9 Ir�sia on) - -
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