P - 75685REQUEST FOR ELECTRICAL INSPECTION
2� o. I��� o�� Minnesota Board of ElecVicity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-OS00 TTY/MRS 1-800-627-3529 wrvw.electvicity.state.mn.us
Describe -using the back of the white copy'rf necessary - the work covered by request:
�%f�L�. tJ l G�S � i�ilJi�
GENERAL FEES Outdoor Lighti Standard @$1
SERVICES / POWER SUPPLIES Tra(fic Sianal Standard C)o. $5
401 to 800
Above 800
;UITS / FEE
0 to 20D !v
CIRCUITS OF LESS THAN 50 VOLTS
3 to 12 Units @$50 Per Untt
FEES
ONE & TWO FAMILY DWELUNGS, EACH UNIT
Includ� the Service and/or Power Supply up to 500 Amperes, /W
Circuits and Two Inspection Trips Each Dwe�ing Unit @$BO
Addftional Ins 'on Td $20
Im�tigative Fee
Reins 'on Fee $20
TOTALFEE
(minimum total f� is $20) ��
TWSAPEpFOR WSPECfQt 16E01'L.Y
I hereby certlfy ttmt I insp�ed tlre eledrlcal 6�VaUon d� herefi on tlre dat� steted:
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"rOF.OFFICE U9E fiNLv
I���UIII��I�����I���I�I�����������0��� �� AUG - 7 2007
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��� Rough-in Inspection Requiredl ❑ Yes � Inspectlon Other Than Rough-In: � Ready Now�ll Call
��— �� You must call the inspector when readyl Da[e Ready.
I certi(q that I am the �CENSED COIdTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspeciion of the ele.ctrical work at
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or, Company or Owner Performing Installatii
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ontrador or Owner Perfortnirm Installadonl
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Llcense Numher Master Electrician or Power Limlted Techn{
Licer�se Idumber
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Pleasa Provide Two (2) Phone Ninnbers Includinu Area Code