P - 75680REQUEST' FOR ELECTRICAL INSPECTION
2 s o 4, o��� 6� Minnesota Board of Electriciry I
1821 University Avenue Suite S-128, Saint Paul, Minn�ota 55104
(651)642-OSOOTTY/MRS 1-800-627-3529 www.eleclricity.state.mn.us
Descnbe -using the of the whde copy'rf ry- the arork cove by this request: �
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.� GENERAL FEES 0 oor Lighting Standard @$1
0 to 400
CIRCURS OF LESS THAN 50 VOLTS
3 to 12 Units C�il $50 Per Unit
IW U IU II IU II �I ���I II (II II I�I II III �� I�
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ONE & 1W0 FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Am�res, AO
Circuils and Two Insp�on Td� Each DweQing Unft �$�
Addfional Inspe�fion Trips @ $ZO
Investiaative Fee
(minimum t�al fee is $20) I � `�
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I herebY c�NtY that I hisP�d the eledrbcal inatalladon desal�d l�erein on tlre dates ataied:
FOR OFF;CE LSE ONLr
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�� c� Rough-in Inspedion Requlred7 ❑ Yes Inspection Other Than Rough-In: ❑ Ready N Call
��'`'� � You must call the inspeaor when readyl Date Ready.
I certify thffi F am
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CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request insp�tion of the electrical wrork at
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9on1 Please Provide Two (2) Phone Numbers Incl
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