P - 75944REQUEST FOR ELECTRICAL INSPECTION
1� g g 7� 9� 7 � Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 T1Y/MRS 1-800-627-3529 www.electric�.state.mn.zcs
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Descn'be -y6�9 t�, aj�pt.thg whjJ�c�PyjF necess�ry - tp�wo� covered by this requasc: - ° w— -
0 to 400
CIRCUITS OF LESS THAN 50 VOLTS
9ystem Device or MP�S C�3 $.�
ADDRIONS TO THE GENERAL I
Manufactured Home Par1c Lots $
Recreatlonal Vehicle Park Sitas
Sa arate Bondinq Inspec8on @ $21
Spedal ins 'on � $30 r Hour
S Ir�spection � $.31 r Mita
THIS INSTALLATION INAY I
ONE & TWO FAMILY DFNELLINGS, EACH UNIT
Includes the Service andlor Powrer Suppty up to 500 Amperes, All
Circuits and Two InspecUon Trips Each Dwelting Unit @$80
Additlomal Ins on Tri $20
Inv�ti ' Fee
Reins 'on Fee $20
TOTALFEE
I (minimum total fee is $20) /
rws a� wa wsr�cma usE onar
I herebY �rti(Y thaz I insPeded fhe elec�ical UretaOatlon d�d herefi on Nre datas sieted:
COMPLETED WITHIN 12 MONTHS
Q� I
FC1R OFFICE USE ONLY
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oace: Ro„gn-m �nspecnon Req�,Uea? ❑ ves �nspec�o„ otlter rF�an gn- . y Plow ❑wrm ceu
/ You must call the inspector rNren readyl Date Ready. (S,�
I certi�fy that I am the 0 LICENSED CONTRACTOR ❑ COMPAWY ❑ OWNER and hereby request inspection of the electrical work at
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�rn f Name �� !�1 // V J �6 /e\ /���( ,/ mbers Induding Area Code
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, Compa�r o�
ise Number Mester Eledri�an or Power Ur
� � �/� Llcense Number
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Ple�e Provide Two (2) Phorre Numbers Indudin�
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