P - 75729REQUEST FOR ELECTRICAL INSPECTION
1_���� 17 5� Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MFiS 1-800-627-3529 www.edectricity.sdate.mn.us
Describe -using the back of whfte copy' necressary - the work coverejl by this requ�t:
0 to 400
)MMUNICAT70N, REMOTE CONTROL, SIGNALING
CIRCUITS OF LESS THAN 50 VOLTS
�ystem Device or Apparatus @ $.50
ADDITIONS TO THE GENERAL FEES
3to12
i Home Park Lots
Vehicle Park Sit�
Transfortners u to 10 KVA $90
Transformers over 10 KVA @$ 20
Trannsformer / Power Supply for Signs / Outlir�a Lig $5
ONE 8 TWO FAMILY DWELLINGS, EACH UNR
Includes the Service and/or Poarer Supply up to 500 Amperes, All
Circuits and Two Inspechon Trips Each Dwelling Unit @$80
TOTAL FEE
total fee is $201
I hereby cer6h fhffi I inspeded tl�e electrical Instellatlon d�aibed herefi on tlre
1 THIS INSTALLATION MAY BE ORDERED DISCONNE,CTED IF NOTCOMPLETED WITHIN 72 MONTHS
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�e' Rough-in Inspectlon R uired? ❑Yes ❑ No Ins
eq pection Other Than Rough-In: Ready-Now �Witl Call
� p� '�� You must wll the inspector when readyl Date Ready.
I certify that I am the L�ICENSED COMRACTQR ❑ COMPANY ❑ OWNER and hereby request inspection of the. electrical work at
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' � Please Prodde Two (2) Ph Numbers
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Address
/� CoMrador License Number Master Electriaan or P�
LGf►�Y� �� / Lk:ense Number
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r(ortn(ng Installatlan)
or Oxmer rming I�Iladan) � ease Provide T�) Phorte Numbers I
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