P - 76080REQUEST FOR ELECTRICAL INSPECTION
�� 016 � 6 61 ,� Minnesota Board of Electricity
1821 Universlty Avenue Suite S-128, Saint Paul, Minnesota 5
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electric' .st
�cribe -usAgtjre�adc of t�ie whitte coPY � ��ry - thP'�rk covered by this request: n , �
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Ofi400
CIRCUITS OF LESS THAN 50 VOLTS
iystem Device or Apparatus @ $.50
ADDITIONS TO THE GENERAL FEES
Fee @ $20
up to 10 KVA
over 10 KVA i
v
Inctudes the Service and/or Poarer Supply up to 5Q0 Amper�, All
Circuits and Two Ir�specUon Trips Each Dwelling Unit @$80
TOTALFEE
total fee is $201
I herebvi certih that I Inspeded tlre electricel insia0etlon desvi6ed herein on Uts da0ea s�ted:
Manufactured Home Park Lots $25
ReaeaUonal Vehicle Park Sites $5 �"'"` °'�10N
Se Bomi Ins on $20 �r
S Ir�spectlon @ $30 r Hour °�°'"�
S Ins on @$.31 per MDe
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITNIN 72 MONT
�OR OF�ICE iFSE OHLY
I IIII II III II 111 II II� I� �II II ��� �II � U� �� I�
20166617
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�� I�� � Rough-in Inspecllon R�uUed? ❑ Yea �No InspecHon Other Than Rough-In:� Ready Now D+MA CaU
You must caU Ure inspector when readyl Date R�dy:
I certify that I am the UCENSED COMRACTOR ❑ COMPANY ❑ OWNER and hereby r�uest inspedion of the electrical work at
Jnh Ske Sheet Addresa�� _ �. � _ Cih�. ..
I'wa (2) Pho�re Nun
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Master Elec6'ida
Licer�se Numbe�'
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