P - 75943% ...
REQUEST FOR ELECTRICAL INSPECTION �r�'
1� 9 9 A� 916 �', Minnesota Board of Electricity , �'
- 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 � -'
(651) 642-0800 T'fY/MRS 1-500-627-3529 www.eleclricity.s te.mn.us '" °�� V
Describe -using th� of t�e wh'�co� �ork fovered by this ��� �� /� �
% � F / d ���%'Y� (J
/ POWER SUPPLIES
° Above 200 Am ere @$10
ALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
3 to 12 Units @$50 Pe
Each Addfional Unft @
Retrofit (� $25 �r Falure
Mile
IIII IIIII IIIII IIIII ��I Ilul IIIII (lul �� I�
1997916Q
Traffic Siunal Standard
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Inctudes the Service and/or Power Supply up to 500 Amper�, M
CircuiLs and Two Inspec�on Tdps Each Dwelling Unit @$80
Additional Ins 'on Tri $20
Irnestigative Fee
Reins 'on Fee $20
TOTALFEE
(minimum total fee is $20) � s �
TH6 AF�A FOR QJSPEClOR USE 0lll.Y
I hereby certify that I inspeded the elechical installaUon desafbed hereN on the dat�
�7 a� �
)NNECTED IF NOT GOMPLETED WITHIN 12 MIONTHS
rnR,;F�ic u,c�,���v
�����, �� �
��� Rough-in Inspectlon ReqWred7 ❑Yes �A�o Ins on Ofher Than Rou h-In:
�� pecti g eady Now Will Call
Y ust call the inspedor when readyl Date Ready:
I cefify that I am the CEN3ED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electricaF vuork at