P - 76128REQUEST FOR ELECTRICAL INSPECTION
1� 7 8 7� 0 6 8 � Minnesota Board of Electricity ��
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.elech-icity.state.mn.us
Deseribe -using tne �dc of the wr,ne copy if ne��Le'�PI�'�i Y'Y���t° S SW T�CH
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GENERAL FEES Outdoor Lighdng Standard @$1
SERVICES I POWER SUPPLIES Traffic Sianal Standard (aZ $5
GRCllITS OF LESS THAN 50 VOLTS
iystem Device or Apparatus @ $.50
� ADDITIONS TO THE GENERAL I
li�ISTALLATION MAY BE ORDEREI
III� III� Ili� II�!! �� II III II Ih III�I III� 11111
178�86�4
ONE 8� TWO FAMILY DVdELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additionallnspectlon Trips @ $20
Investiaative Fee
TOTAL FEE e:Ue
total fee is $201
I inspected ihe electrical installatlon d�critred herein on the datas s�: I
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WITHIN 12 MONTHS
u C/ 14 f.06 Rough-in Inspection Required7 ❑ Y� �] No Inspec[ion Other Than Rough-In: [�Ready Now ❑ Will Call
You must call the inspector when readyl Date Ready:
I cs�tify 4hat I am the C�] LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
J0l��L� h!`�`AI�LE ST °� ' �• ,:�''
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Fc2C CORFaFiAiId�1
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or Owner Performing
Range
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Please Provide Two (2) Phone Numbers Including Area
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:onvac[or ucense rvumoe� master tlecVir�an or Power Limitetl l
C�j !��$�j ucenae Number
q Mh! 55114
Please Provide Two (2) Phone Numbers Including Area
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