P - 78555REQUE L INSPECTION
1� 3 5 0�� 9 8 Minnesota Board of Electricity
r � W 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
�� (651) 642-0800 TTY/MRS 1-800-627-3529 -
www. electrici ty. state. mn. us
Identity the work covered by this request: Q� � i� L���
❑NEW ❑REMODEL ❑ADDITION ❑REPAIR � 6�,�(.'�� l l C.t �—C Q . y
to 400 A
11 to 800
�ove 800
IITS / FE
�u 200 Ai
CIRCUITS OF LESS THAN 50 VOL'
Su lemental Fee � $20
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transfortner / Power Su for Si ns / OuHine ' htin �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service anNor Power Suppty up to 500 Amperes, All
Circuits and Two Inspeotion Trips Each DweNinq Unit �$8L
Fee
Per
Park
FOR OFFICE USE ONLY
I ��
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Re�st Date�,,� � Rough-in Inspection Required? ❑ Yes o
(minimum total fee is $20) I�`
e
��
the electrical installation described herein on tl�e dgtes s�ted;
OtherThan
/G��
NITHIN 18 MONTF
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❑ Ready Now WIII G
� `� �'� L� ��--� �I You must call Me inspector when readyl , I Date Ready: � �
I certify that I am the �'LICENSED CONTRACTOR ❑ CpMPANY ❑ OWNER and hereby request inspection of the elecVical work at
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�NSTRUCil01� ON BACK OF YELLOW COPY