P - 77657REQUEST FOR ELECTRIC� IN PEC O �
1QQ f Minnesota Board of Electricity (/'��- ���� � °�
� iJ V 1- 6 0 6 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-B00-627-3529 www.electricity.state.mn.us
Describe -using the back of the white copy if necessary - the work GOVered by this request: �__ ' `
/
0 to 400 Ai
401 to 800
Above 800
CIRCUITS, CIRCUITS OF �ES THAN 50
Each S stem Device or
ADDITIONS TO THE I
MULT�FAMILY DWELLINGS PER U T
3 to 12 Unfts @$50 Per Unit
Manufactured Home Park Lots i
Recreational Vehicle Park Sites
Fee
�
over
Includes the Service andlor Power Supply up to 500 Amperes, All
ALING Circuits and Two inspection Trips Each Dwelling Unit @$80
Additional Ins ction Tri s $20
Investi ative Fee
FEES � Reinsoection Fee (�a $20
total fee is $20) I �
I hereby certify that I inspected the electrical installatlon described herein on the dates stated: �
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THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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vaie: Rough-in Inspection Required? ❑Yes �o Inspedion Other Than Rough-In:s�qeady No ill Call
You must cail the inspector when ready! Date Ready:
I c rtify that I am the�ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Site Street Address C8y
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Please Provide Two (2) Phone Numbers Including Area Code
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Contractor License Number Mast ElecViaan or Power Limited Techni
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