P - 75752�
REQUEST FOR ELECTRIC L I SPECTION
I d.� � 3 4�'0 ��� � Minnesota Board of Electricity p���� ��,��?f �/
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55'ia4
(651) 642-0800 TTY/MRS 1-800�27-3529 www.edectricity.state.mn.us
Descnbe - mg the back of whde copy ff necessary - the vnork covered by this req�a&,tit:
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GENERAL FEES Outdoor Liahtina Standard (�a �1
I SERVICES /
Above 200 Am ere $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Far,h m Device or @ $.50
ADDIT10NS TO THE GENERAL FEES
3 to 72 Unfis @$50 Per
Each Addfional Unit Cd! 9
.LATION MAY BE ORDERED I
�) � I� �I ul � UI II I� II Iu II I� II �I �� I�
18341461
Traffic
ONE 8 TdVO FAMILY DdVELLINGS, EACH UNIT
Inctudes the Service andlor Power Supply up to 500 Amperes, M
Cirauts and Two Inspectlon Trips Each Dwelling Unit @$80
TOTALFEE I � � �p
total fee is $20) P
I hereby cerdfy that I inspeaed the electrical InstaVatlnn d� herein on the daf� sfafed: �
APLErED WITHIN
FUR flEFICE USE' ONLY
��y��� I
"a�' Rough-in InspecUon R
�^„�� equired? ❑ Y� No Inspecdon Ofher Than Rough-In: ❑ Ready Now � WN CeII
�' j You must call the i�pedor when readyl Date Ready:
I certiRy tliat I am the CENSED CONTRACTOR ❑ COMPANY ❑ OWNER arid hereby request inspection of the electric�al work at
Job Ske Street CqY
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�-$4�( �sc) �`�
Mester Electridan or Poaer Wnite
uc�r�se Number
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YEILOW COPr Bon�to oF e�Fr.mir.m r.�w . �. �o.,�,. ,� o,�.