P - 760941 7 8 7 0 7 3 4 REQUEST FOR ELECTRICAL INSPECTION
� � ❑ Minnesota Board of Electricity _ ;
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-OS00 TTY/MRS 1-800-627-3529 www.electricity.state.mra.us
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SUPPLIES
Fee
�re m y� ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
re$10 Includes the Service and/or Power Supply up to 500 Amperes, All
9CATION, REMOTE CAMROL, SIGNALING Circufts and Two Inspection Trips Each Dwelling Unit @$80
ITS OF LESS THAN 50 VOLTS Additional Ins cdon Tri @$20
Device or Apparatus @$.50 Investigative Fee
)DITIONS TO THE GENERAL FEES Reins ction Fee $20
ELLINGS PER UNI TOTAL FEE LO, �(j
�$50 Per Unit . (minimum total fee is $20)
71 Unit @ $25 THISAREAFORWSPECTORUSEONLY
OTHER ADDITIONAL FEES
flt �$.25 pef Foctufe I hereby certify that 1 inspected the electrical inshallatlon described herefn on the datas afeted:
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Hour
t THl51N5TALLATION MAY BE ORDERED DISCONNECTED_IF NOT COMPLETED WITHIN 12 MONTHS _�
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17B70734
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1$/ � 41a� Rough-in Inspectlon Required? ❑ Ye� � No Inspection Other Than Rough-In: �Ready Now � Will Call
You must call the inspector when readyl Date Ready:
I�r§ty that I am the L�j LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work ak