P - 76183°� REQUEST FOR ELECTRICAL INSPECTION ��°i
2� 0 5� r,a o� 3� � Minnesota Board of Electricity �I
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-500-627-3529 www.edectricity.state.mrr.us
Des�ibe -using the back of th� white copy'rf necessery - the work covere�i by this request: �
� . . � . ��
UGENI
SERVICES / PD� R SUPPLIES
0 to 200 Am ere (al, $5
Above 200 Am ere a$10
AIARM, COMMUNICA110N, REMOTE COIdTROL, SIG!
CIRCUITS, CIRCURS OF LESS THAN 50 VOLTS
Each S m iTevice or A paratus @$.50
ADDRIONS TO THE GENERAL FEES
3 to 12 Unils @$50 Pe
Each Addibonal Unit @
Retrofit
IIIII u I� II ��I II ul I�I�I � III U ul �III �� 1�
2059339�
Standard
ONE S 11N0 FAMILY DWELLINGS, EACH UNIT
Ir�cludes the Service and/or Power Supply up to 500 Amperes, Ail
Circuits and Two Irxpecbon Trips Each Dwelling UnK @$80
�v�n�rcc
total fee is $20)
I frerebvi certl(v fhef I �nspaded the electricel inslaVatlon desrnbed herein on fhe dates etsted:
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�� Rough-in Inspection R�uired? ❑Yes '�No InspecHon OtherThan Rough-In: [°fReady Now ❑WIII Ceil
L�� ��+ �� You must call the irrepector when readyl DaGe Ready. ��� er ���
I ceitify that I am the ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspedion of the electrical work at