P - 75978REQUEST FOR ELECTRICAL INSPECTION -�_..,.
�� 0��� 31 �� Minnesota Board of Electricity <
1821 University Avenue Suite 5-128, Saint Paul innesota 55104
(651)642-0800TTY/MRS1-800-627-352 tectricity.state.mve.us
Describe -usir�g the back of fhe mrhite copy'rf necessary - the work covered by this request: ��
GENERAL FEES Outdoor Liqhtinq Standard C� $1
0 to 400
;UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System IIevice or Apparatus @$.50
ADDRIONS TO THE GENERAL I
Cerder Pivot
1 eoom C
Park Lots
ONE & 1W0 FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, AO
CircuiGs and Two Inspeclion Trips Each Dwelling Unit @$80
total fee is
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I herebv mrtHv thffi I ins�d dre elecUir�l ir�allallon deacdbed herefn on ttre de0as stated: �
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IflISTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITF
FOk iiFFICE �JSE �.hvLY
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�� Rough-in Inspectlan Requir�i? ❑Yes � Inspectlon OtherThan Rough-in: �Ready Now ❑Wip Call
� QV ��� You must call the inspector when readyl Date Ready.
I certify that I am the UCENSED CONTRACTOR �OMPANY ER and hereby requ�t inspection of the elec6ical work at
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�mpany Name
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s (ContractRr, Company
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Contredor License Numbet Master Electrician or Pawe
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In on Please Provlde Two (2) Phone Numbers Ind�
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