P - 76155REQUEST FOR ELECTRICAL INSPECTION "'
�°� o� V�� 14 � Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minrresota 55104
e (651) 642-0800 TTY/MRS 1-800-627-3529 www.edectricity.state.mn.us
Descdbe -usir�g th ck o� wh� py'rf�� �� covere�i by this requa4t: —7
l Ca� � � / %'? — `? $� � S
0 to 400
Fee
Above 200 Am re$7D '' Tncludes the Service andlor Power Supply up to 500 Amperes, All
tM, COMMUNICATION, REMOTE CONTROL, SIGNALING Ciraiits and Two Inspection Trips Each Dwellir�g Unit @$BO
,UITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins on Tri $2(1
Each System Devlce or Apparatus @$.50 Investisaative F�
Cerder
Unk @
Hour
total fee is
I h�eby certl(y that I ins�ded fhe ei�trical inata�atlon de�ed herefn on 9�e det�
FOR �FIGE USE �JNLY'
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1iR" Rou h-in Ins
o�� g pection Requfred7 ❑ Yes o InspecUon OUier Than Rough-In: � Ready Now Wfll Call
$' o You must caA the inspectur when readyl Date Ready.
I certify tl�at I am the�`UCENSED CONTRACTOR ❑ COMPANY p OWNER and hereby request inspection of the electrical rk at
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