P - 78792REQU�ST FOR ELECTRICAL INSPECTION -
1� 4 �8 3�- 316 � Minnesota Boa�d of Electricity '
1821 Universify Avenue Suite 5-128, Saint Paul, Minnesota 55104
• (651) 642-0800 TTYIMRS 1-800�27-3529 www•electricity.state.mn.us
❑ NEW ❑ RE ODEL ADDITION ❑ REPAIR Desc�e -using the back,pf the white c9�y if necessary - the work coveredpy this request:
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ONE 8 TWO FAMILY DWELLIN�S, EACH UNIT
Includes ihe Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Huui i wiva i v �� �� ���.�� -•_ •__.. TOTAL FEE I V`+�
fIFAMILY DWELLINGS PER UNI (minimum total fee is $20)
3 t0 72 Units @$50 Pet Unit TpS�q�FppIHSPECi0RU5E011Y
Each Addi6onal Unit �$ZS I hereb7 cerdry that 1 inspected Me e�ectrical insta�a�^ ��� ��^ a^ ���d'
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I certify that I am the �
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Rough�n Inspection Required? ❑ Yes ❑ No Inspedion Other Than Rough-In: ady Now 0 Wfll Call
You must call the inspector when ready! Date Ready: .
NSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
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