P - 76109REQUEST FOR ELECTRICAL INSPECTION
1� 7 8 7� � 8 8 � Minnesota Board of Electricity ',
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TfY/MRS 1-500-627-3529 www.elecri-icity.state.mn.us
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GENERALFEES
C4RCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL FEES
MAY BE ORDERED
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17870882
Traffic Siqnal Standard
� Transformer / Power Supply for Signs / Outline Lighting @$5
ONE & NVO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Ttips Each Dwelling Unit @$80
Additional Inspection Trips @ $20
Investiaative Fee
TOTALFEE t�o
total fee is $201
iat I inspected the electricel installetlon d�cribed herein on the dafes s�ted:
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D OAIE
JOT COMPLETED WITHIN 12 MONTHS
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�' Rough-in Inspection Required7 ❑ Ye � No Inspecdon Other Than Rough-In: [�CReady Now ❑ W(II Call
8/14/06
You must call the inspector when readyl Date Ready:
I c.ertify �tat I am the C� LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at