P - 75904� REQUEST FOR ELECTRICAL INSPECTION
1��� 9- 2 61 6 Minnesota Board of Elecficity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TfY/MRS 1-800-627-3529 www.electricity.state.mn.res
D�cribe -using the back of the ite coPY if nec�sary - the work covered by this requ�:
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GENERAL FEES Outdoor Liahtirm dard (a� $1
Above 800
CIRCURS / FEI
CIRCUITS OF LESS THAN 50 VOLTS
3 to 12 Units (a� $50 Per Unit
Spedal Inspecfion @ $30 per Hour
S I� on @$.31 r Mile
THIS INSTALLATION MAY BE ORDERED
I IIII II III h�i Il �II II I�I II II� il III II III n� I�l
� 18692616
Fee
Includes the Service and/ar Power Supply up to 500 Amperes, All
Circulis and Two Irus�ctlon Trips Each DwelGm,� Unit @$BO
AddiUonal Ins on Td $20
Investi ative Fee
Reins 'on Fee @ $20
TOTAL FEE pp�
(minimum total fee is $20) �
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I hereby t�ertl(y Umt I 6�d tlre electriral InstaOatlon d�a3ed herein on tlre datea �eted:
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1 Rough-In Inapectlon Required9 �Yes ❑ No I�pectlon Other Than Rough-In: � Ready Naar �1N� Ca0
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I certify that I am the UCENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspe.ction of the el�trical work at
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