P - 75981REQUEST FOR ELECTRICAL INSPECTION
�_ 017 �� 9� � Minnesota Board of Electricity I
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
r� �� (651) 642-0800 TlY/MRS 1-800-627-3� www.electrecity.stade.mr�.us
rDescribe - 9 the j�adc of the„vqhite copy if necess� - the work covered f� this tequ n_ �_ ' f
:UITS / FEEDERS
o to zoo am�re �m �
Above 200 Ampere @$10
tM, COMMUNICATION, REMOTE CONTROL, SIGNALING
:URS, CIRCUffS OF LESS THAN 50 VOLTS
3 W 12 Units @$50 Pe
Each Addltior�l Unit �
OTHE
ua�mr� Revom cm $.z:
over 10 KVA [rD $ 20
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includ� the Service and/or Power Suppty up to 5Q0 Amper�, NI
CircuiGs arM Two IrrspecUon Trips Each Dwelpng Unft (a� $80
TOTAL FEE
total fee is $20)
I hereby ceriHy thffi I i�ed tlre elearical 6�tallatlon d�aibed hereln on tlie dates atat�:
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ALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 1;
FOR OFFtCE USE ONLY
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�� Rough-in Inspectlon Required? ❑ Yes ❑ No Insperdion Other Than Rough-In�Ready Now � WUI CaA
��� ` 1 '��� You must ca0 fhe inspectorwhen readyl Date Ready. s
I certify that I em the �LICENSEQ CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection ofo,tl�e electrical wo�ic at
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Mrador License NumF�r Master dectridan or P
,/� ��� � llce�e Number �
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Please Provbde Two (2) Phone Numbeis I
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