P - 76344REQUEST FOR ELECTRICAL INSPECTION
G���f� � 4 5 3 Minnesota Board of Eledricity
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
� (651) 642-0800 TTY/AARS 1-800-627-3529 www.edectricity.state,
I SERVICES / POWER SUPPLIES
0 to Z00
IMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS OF LESS THAN 50 VOLTS
3 to 12 UniGg (d� $50 Per Unit
S I�pedion $30 r Hour
Sp�al Uispecdon @ $.31 per Mile
THIS INSTALLATION MAY BE ORDEREI
(lul uW UW UII� II�II II��UTA IIIII �� ��
21444534
Includes the Service andlor Pawer Supply up to 500 Amperes, AII
Circuits artd Two Inspecfion Trips Eadi DwelGng Unit @$BO
Addi�onal Inspection Trips @ $20
Inve,stiaative Fee
total fee is
I IrerebY certlfY d�at I I�peded ths electrlcal
FOR OfFICE USE ONLY
f�CD �AY 1(4 200�
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Rough-in Inspectlon Requhed? LJ Y�� Inapectlon O�er Than Rough-I Now OdVN Ca0
��I � You must call tlre inspector when readY! Date Ready. C� � �� I
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I certify tl�at I am the�IL ENSED CONTRACTOR ❑ COMPANY ❑ OWNER and.hereby request inspection of�le electrical work at
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