P - 75462'REQUEST FOR ELECTRICAL INSPECTION `
1 �20 460 �-
� � � Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-OS00 TTY/MRS 1�00-627-3529 www.electricify.state.mn.
D�cn'be -usir�g the back of the white copy if necessary - the work coverai by this request:
�.�n•..�.� e�.-I-P� �...0 s�.�-� C) b►�o.�,� �
0 to 400 Ampere @$25 Supplemental Fee $20
407 to 8D0 Am re $50 Transfortners u to 10 KVA $10
Above 800 Am ra $75 Transformers aver 10 KVA $ 20
:UITS / FEEDERS Transfartner / Power Su I for Si s/ Outline LI h' $5
0 to 2� Am re$5 ONE & TWO FAMILY DWEWNGS, EACH UNR
Above 200 Am re$10 Includ�s the Service and/or Power Supply up to 500 Amperes, All
2M. COMMUNICATION. REMOTE CONTROL. SIGNALWG Circuits and Taro Inspecbon Trips Each Darelflng Unit �$60
GIRCURS OF LESS THAN 50 VOLTS
iystem Device or Ap{raratus @ $.50
ADDI170NS TO THE GENERAL FEES
TOTALFEE
total fee is $20)
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ManufacWred Home Park
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Sp�fal Ins on @$.31 r Mile `-� m" `�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF PIOT COMPLETED WITHIN 12 M THS
FpR OFFICE USE ONLY
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��� Rough-ln Inspectlon Required7 �Yes ❑ No Inspedion Ofher Than Rough-In: ❑ Ready Now� I
� C�/ �` �� You must call the inspector when readyl Date Ready:
I cerrtiffy that I am the � LJGENSED CONTRACTOR ❑ COMPANY I�'OWIdER and hereby request inspection of the ectrical work at
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Contrador License Number as[e lectrician or
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Slgnafure (Contrador or Owner Performing InstaVaUon) Please Provide Twa (2) Phorre Niunbera Includirtg Area Ca
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