P - 75829REQUEST FOR ELECTRICAL INSPECTION � �
1� 9 3 6 a 7 V S � Minnesota Board of Electricity
1821 University Avenue SuRe S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 .cfle 'ci .state.rvan.us
Desai -us�g. e� the wtrite copy�H2�%s�ry� work ered by this uest:
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CIRCUITS OF LESS THAN 50 VOLTS
iystem Device or Aaoaralus (� $.50
3 to 12
Park Lots
,� � aTION MAY BE ORDERED [
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1,9367689
Su lemental Fee $20 G � ' • , .
Transfortners u � to 10 KVA a,
TransFormers over 70 KVA Q$ 20
Transfortner / Power Su I for Si s/ Outline Li htln $5
ONE & TWO FAMILY DWEWNGS, EACH UNIT
Indudes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additionallns ection Tri�s a $20
InvestigaBve Fee
Reins �tion Fee a $20
TOTALFEE
(minimum total fee is $201 a' �
I hereby certlty fhat I Inspedad tlre electrlml h�fslladon described herein an the dates stated: �
'ED IF NOT COMPLEI'ED WITHIN 12 MON1
F R i��FICc UuE O�tiLI'
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+� � � g pecdon Required7 ❑ Yes o Inspectlon Other Than Rough-In: ❑ Ready Idow WiA Call
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�J ou must call the inspector when readyt Date Ready.
I cer8fy that I am th�ICENSED CONTRAGTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
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T ship Sectlon Range Fire No. CouMy ^ �
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