P - 76335REQUEST FOR ELECTRICAL INSPECTION� �`
2 s o�•� �� 3 5� Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
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Abova 8�o Amper
;UITS / FEEDERS
0 to 200 Amnere 6
(651) 642-0800 TTY/MRS 1-800-627-3529 www.edeciricity.state.mn.
copy if nec�ssary - the veork corered by this requsst:
�o.e, S� r� C)n a�-r �
200 Ampere @$10 �
1MMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS OF LESS THAN 50 VOLTS
3 to 12 Units @$50 Per Un�
I THIS
FEES
Hour
Includes the Service and/or Power Supply up to 500 Amperes, M
Circui� a� Two Ins�on Trips Each Dwelling Urrit @$80
Additional Ins 'on Tri @ $20
Inv ' ative Fee
Reins 'on Fee $20
TOTALFEE
(minimum total fee is $20) b c�
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I hereby cflttifythat I i�ed ths electrical U�tellaUon d�d herein on fhe datas stated:
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COMPLETED WITHIN 12 MONTHS
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20169355 p�,���'11����
��� Rough-in Inspecdan ReqWr�7 �Yes ❑ No Inspectlon Other Than Rough-In: 0 Ready Now III Call
(V ��,J ° v� You must call the inspec[or when readyi Dffie R�dy.
I certify that I am the i� UCENSED COMRACTOR ❑ COMPAPIY ❑ OWNER and hereby request inspection of the elecUical work at