P - 75463REQUEST FOR ELECTRICAL INSPECTION �
�'� �`� � 2 V 6 � Minnesota Board of Electricity
1821 University Avenue Suite S-128, Sairrt Paul, Minnasota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.edectriciJy.state.mn.us
D�cribe -using the back of the white copy'rf necessary - the work covered bythis �equest: °
`� n S-E�. l 1;.. < C FI ' S o,J'tie �n t v� ¢�� Cc��iy j�� e,{ ✓1 �5� /4,5 ��
Above 200 Am ere a$10
ALARM, COMMUNICATION, REMOTE CANTROL, SIGNALING
CIRCURS, CIRCUITS OF LESS THAN 50 VOLTS
Each Addibomal Unit @ $25
OTHER ADDITI01
LiaMina Retrofit Cr� $.25 r�r Fodure
�ae
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18202861
Traffic Signal Standard a $5
Su Iemental Fee (a� $ZO
Transformers u to 10 KVA $9
Transformers over 10 KVA $ 2
Transfarmer / Pavrer Su I for S
ONE 8 TWO FAMILY DWELLINGS, E
Includes the Servi� amUor Poarer Su
Circuits and Two InspecUon Trips
AddiBonal Iruspedion Trips @ $Z(
Invesfi ative Fee
Reins on Fee $20
TOTAI
(minimum total fee is
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I herebY ce�Y that I the electrical
y up to 500 Amperes, All
Each Dwelling Unft @ $80
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3 i�rerein o� U�0
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IF NOT COMPLETED WITHIN ''�t` ONTHS
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� � Rough-In Inapecfion Requir�7 ❑ Yea Inspedion Other Than Rough-In: 0 Ready Naw 0 WUI Call
��_ b You must call the inspector when readyl Date Ready:
I certify that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY
Job Site Street Addr�s
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Electrical UtUfty Address
ar�d hereby request mspection af the electrical wrork at
cny
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(7�)Y�3 ` ��� (�da) � z °�b3�
rwe N�r Master Electrician or Power Ltmited TechNclan
Li�n� Niunber
Please Provide Two (2) Phorre Niunbets Inrduding Area Code
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