P - 75456REQUEST FOR ELECTRICAL INSPECTION
���� o� 4 71 � Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.edectricity.state.mrr.us
Describe -using the tradc of the white copy'rf necessary - the work covered by this requ�t:
. ��(i�w . �O� /9/'Xr el �.►��\. _ c�ne.� n — s! .Q.�.�� _ /` �l/"P e.,
POWER SUPPLIES
Above 200 Am ere a$90
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCURS, CIRCUffS OF LESS THAN 50 VOLTS
Each Addidonal Unit @ $25
OTHER ADDff101
Unhtlna Retrofit CcA $.25 aer Fodure
LATION MAY BE ORDERED �
I uu u ul II W I� W II W I� I� II (� � I� �� I�
18204719
Transformers u to 10 KVA �$10
Transformers over 10 KVA $ 20
Transfomrer / Power Su I for Si r�s / OutGne ' $5
ONE 8 T1N0 FAMILY DWELLINGS, EACH UNIT
Includas the Service and/or Power Supply up to 500 Am�r�, Au
Cin:uits ami Tvro Inspection Trips Each Dwelling Unit @$80
Addfionallns onT' $ZO
Ime.stigative Fee
Rei� 'on Fee $20
TOTALFEE /
(minimum total fee is $20) �`f �d
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��� Rough-in Inspection R�ulred? ❑ Yes ❑ No Inspecdan Other Than Rough-In: ❑ Ready Now ❑IN01 CeII
!Jv I 2— G� You must cell the imspedor when readyl Date Ready.
I certify that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY ,� OWNER and hereby request inspection of the electrical vuork at
Job Site Street Address City
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(�) SN�E z8�3(
ise Number Mester Elec6ldan or
Licerise Num6er
Please Provide Two (2) Phorre Number
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Area Code I