P - 76220_ REQUEST FOR ELECTRICAL INSPECTION
1 s 9����� q, � Minnesota Board of Electricity
1821 University Avenue Suite S-128, Safnt Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-SOa627-3529 www.edeciricity.state.mn.us
D�ai� -usir�g the back the e copy'rf n�ry - the yprk cove by this requast: -
CIRCUITS FFEEDERS
0 to 200 Am re $5
Above Z00 Am re $10
ALARM, COMMUNICATION, REMOTE COPITROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
to 12 UnNs id �50 Per Unit
THIS INSTALLATION MAY BE ORDERED
I�� � �� 0 �� �� �� a �� 0�I �� �� ��� �� ��
19633544
Standard
Tra�formers u ro 10 KVA $10
Transformers wer 10 KVA @$ 20
� Transformer / Powrer Supply for Signs / Outrme Lightlng @$5
ONE & TWO fAMILY DWELLINGS, EACH UNIT
Includes the Seroice artd/or Paxer Supply up W 500 Amper�, AA
Circuits and Two Inspection Trips Each Duvelling Unft @$80
total fee is $20j I r��� I
tl�at I tr�ed fhe elecbical fisiallatlon desaH�ed herein an tlie dafes s�ed:
COMPLETED WITHIN 12 MONTHS
FOR aFFICE USE ONLY
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�� Rough-in Inspecdon RequiredT ❑ Yes ❑ No Inspecdon Other Than Rough-In: y Now �1N� Ca0
�� f� �� You must caU the inspedor when readyl Date ReadY-
I certify tl�at I am tMe �CENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical xrork at
Job Site Straet Ad a f � � City � `�
��C.
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Master Dectridan or Povsr Limited T
License Number
Two (2) Phorre Numbers Ir�cludUtg Area
� ., �L� 4� / �
�
E8-00001A-15