P - 75892REQUEST FOR ELECTRICAL INSPECTION
1� 9 9 7���� � Minnesota Board of ElecVicity
1821 University Avenue Sufte 5-128, Saint Paul, Minn�ta 55104
(651) 642-0800 TfY/MRS 1-800-627-3529 www.edectricdty.state.mn.us
Desaibe -usiria�h� l5ack of th white copy ff n ry- the work ered by is requ :
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GENERAL FEES Outdoor Li hting Standard @$1
SERVICES / POWER SUPPLIES Traific Simial Standard (6D $5
Above 800
CIRCUITS OF LESS THAN 50 VOLTS
3 to 12 Units (a� S50 Per Unit
Hour
S�
THIS
ONE & TWO FAMILY DWE
Inciudes the Service and/or
Ciraiits and Two Inspectlon
Additional Ins ection Ti
Investiaative Fee
to�� �S
Y �P to 500 Amperas, AO
Each Dwelrmg Unit @ $BO
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I hereby wrbfy tltaz I Inspeded the electrical Utslallatlon des�ed herein on tlre dates sta�f:
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IF NOT COMPLETED WITHIN 12
i=OR OFFICE USE ONIY
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�� Rough-In Inspecdon Required7 ❑Y� ❑No Inspecdon OtherThan Rough-In: Ready Now ❑W01 CeU
� Z� =� v You must caA Uce drepector when ready! Date Ready:
I�rtify tl�at I am the CEMSED CONTRACTOR ❑ COMPAWY ❑ OWNER and hereby request inspection of the electrical work at
Job Site Street / � � ��� A ' /� . • / � /� , ��Y /� ^�.B
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n) Please Provide Two (2)� Ntunben
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