P - 78347REQUEST FOR ELECTRICAL INSPECTION
1� 512 - 216 � Minnesota Board of Electricity -
1821 University Avenue Suite S-128, SaiM Paul, Minnesota 55104
.�� l..(� q� (651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
❑ REPAIR Describe -using the back of the white copy if necessary - the xrork covered by this request:
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S Outdoor Liahfina Standard � S7
CIRCUITS OF LESS THAN 50 VOLTS
ivstem Device or Anoaratus (o� 5.50
3 to 12 Units
Each Additio�
I IIII II III II III II III II III II III II III II III II � I IIIi.
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ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes tt�e Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$80
TOTALFEE �7
(minimum total fee is $20) ��`"
THIS AREA FOR WSPECTOR USE p1Y
I hereby cer6fy that I inspected the electrical insfalla6on described herein on Uie da�s sf�ed:
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D IF NOT GOMPLETED WITHIN 12 MONTHS �
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rceques[ ua[e: Rough-in Inspection Required? ❑ Yes �No Inspedion O[her Than Rough-In: �Ready Now�Nlll Call
�� 1���� You must call the inspector when ready! Date Ready:
I certiiy tliat I am the �ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at: