P - 78937:1-626-06� �3
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r0 NEW REMODEL 0 ADDITION ❑
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;UITS, CIRCUITS OF LESS THAN 50
Each SYStem Device or Apparatus �
REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electriaty
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800�27-3529 www.electricity.state.mn.us
'AIR Describe -using the back of the white copy if necessary - the work covered by this request:
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20
ONE & TWO FAMILY DWELLIN�S, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two inspection Trips Each Dwelling Unit @$8Q
fIFAMILY DWELLIN�S PER UNI 70TAL fEE sQ
3 to 12 Units @$50 Per Unit (minimum total fee is $2�) �°
rHls MEA FaR I15PECTdi USE 011r
Each Additional Un+t �$25 I hereby cerAry that I inspecled the ekctric� insWlation described Icerein on Uie d�es sfaled:
OTHER ADDITIONAL FEES � � � . d�
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ne9� �� Rough-in Inspedion Required7 U Yes �.�b Inspection Other TTian Ra�gMn: UReady Now�lYNl CaH
�— a— �+ You must call the inspedor whan reedyl Date Ready:
I ce►tify Uiat I am the �`IICENSED CONTRACTOR ❑ COMPANY ❑ OUVNER and hereby request inspection of the electrical work at: