P - 78995/� ,p^ REQUEST FOR ELECTRICAL INSPECTION
�� 6�F 7—� 8 C7 � Minnesota Board of Electricity -
°` 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 •. � :
C� ��S ` (651) 642-0800 TiY1MRS 1-800�27-3529 www.electricity.state.mn.us ""
❑ NEW REMODEL ❑ AL�ITION ❑ REPAIR Describe -using the back of the white copy 'rf �ecessary - the work covered by this request:
I POWER SUPPLIES
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aouaratus �$.50
Retrofit � 5.25 per Fixture
. , , _
Fee @ $20
uplolOKVA@$10
over 10 KVA Ca18 20
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes ihe Service andlor Power Supply up to 500 Amperes, All
Cirouits and Two Inspec6on Trips Each Dwelling Unit �$60
TOTAL FEE I /-�/� �(J
(minimum total fee is $20) pCCJ
THIS AREA FOR INSPECTOR USE OKY
I hereby certiry Mat I inspec0ed the elecBrical installation described herein on the da�s a'f�ed:
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ReQ� �: Rough-in Inspection Required? � Yes Irupedion Olher Than Rough-In: ❑Reedy Now I Call
�—' S� � You must cen the insDecfor when ready! Date Ready:
I certify that I am tl�e �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and her�eby request inspection of tlre electrical walc at: