P - 75940REQUEST FOR ELECTRICAL INSPECTION �°
1� 9� 7� 9 0�� Minnesota Board of Electricity
1821 University Avenue Suite S-128, Sairrt Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-SOQ-627-3529 www.edectriciry.state.mn.us
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401 to 800 Am ere $50
Above 800 Am ere $75
CUITS / FEEDERS
0 to 2tt0 Am re
Above 200 Am re 10 �
ALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER AD
Lightirm Retrofit (dD $.25 oer F
I THIS
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19979079
TraRc Sipnal Standard
Includes the Service and/or Power Supply up W 500 Amperes, All
Circuits and Two Insp�:tion Trips Each Dwelling Unit @$BO
Addi�omdl Inspectian Trips Q $20
Investipative Fe�
total fee is $20) I � ' � �
I hereby tBNfy that I inspect�l ifre electrical insfalla8on desaibed herein on N�e dat� steted:
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�ECTED IF NOT COMPLETED WITF
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uaw„ I /� Rough-in Inspection Re.quiredl ❑Yes �
o Inspection Other Than Rough-In: Ready Now Cali
5 ZLi � ou must call the inspector when ready! Da6e Ready.
I certifythat I am the ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job S'Re Street Address C�y
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Please Provide'�wo () Phorre Numbers Including Area
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�e Co�ac[or Lloense Niunber Master ElecMdan or Power Ltrni[ed Technidan
S�+ ���.i i1%/1 it � /' /�•. � �� License Number
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MS7RUC770N8 ON BACK OF
illaUon) Please Provida Twa (2) Phone Numbers Including Area Code
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BOARD OF ELEC RICRY COPV E&00001 A-15 A 1 9004