P - 75684REQUEST FOR ELECTRICAL INSPECTION
�� 0 1�� 10 9� Minnesota Board of Electricity
`� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.edectricity.state.mn.us
Descrit� -usirtg the back of the white copy ff ne�essary - the work covered by this uest:
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GENERAL FEES Outdoor Li hti� Stansiard @$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Ampere (�a. $25 Supplemer�al Fee (� $20
CIRCUITS OF LESS THAN 50 VOLTS
3 to 12 Units (dR $50 Per Unit
Hour
III��III��InIHIIiIIIIIIIIIi{IIIIIIQ�I�
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ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, AO
Circuits and Two Inspecfion Trips Each Dweliing Unit @$80
Addfionallr�s 'onT' $20
Irnesti ative Fee
Reins 'on F� $20
TOTALFEE
(minimum total fee is $20)
ilil9 AFffA FOR WSPEtTOR U&E OM
I hereby certl(y thet I inspected the elechical NataOatlon desaibed herein on the daies slated:
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RECD AUG - 7 2001
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�� Rough-in Inspectlon Requlred4 ❑Y� �o Inspectlon Other Than Rough-In: � Ready Now�V6ifl Ceq
� -(� °j You must call the inspector when readyl Date Ready.
I certify that I am the�ENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical wrork at
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ry or vwner rertortnmg u
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ro (2) Phone Numbeis Includtr
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Master d�trician or Poarer Li
Llcense Number