P - 75688REQUEST FOR ELECTRICAL INSPECTION
2� 0 7'� 111 �6 Minnesota Board of Electricity
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mrr.us
D�ibe -usmg the back of the white copy if necessary - the wrork covered by this r�uatit:
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GENERAL FEE Outdoor Lighting Standard @$1
SERVICES / POWER SUPPLIES Trafic Sianal Standard C�a. $5
Above 800 Am ere a$75
CIRCUITS / FEEDERS
0 to Z00 Am re $5
Above 200 Am re $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCURS, CIRCUITS OF LESS THAN 50 VOLTS
Each Add'�Uonal Unft @
FoQure
UII uUl O�U �III IIIII (IIII IIIII ulll �� I�
'�701116
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Inciudes the Service andlor Power Supply up to 500 Amperes, A�
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additlonallnspectlan Trips @ $20
Investiaative F�
total fee is
I hereby certi(y thet I Inspeded the elecLical i�llatlon desaibed hereN on fhe datea staDed:
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�L)k GFP(�E USE UNLv
{��p AUG 13 2001
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�� Rough-in Inspecdon R�uired9 ❑Yes �No InspecUon Other Than Rough-In: ❑ Ready Now�{i0 Call
��_ �% � You must call tlie Inspedor when readyl Date Ready:
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I cefify that I am the�ENSED CONTRACTOR ❑ COMPANY ❑ OUNNER artd hereby request inspection af the electrical work at
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�mpany or Owrter Perfortni
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:tor or Owner Performing I
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Plea� Provide Two (2) Phorre Numbers I
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Utilily Address
� _ „ !� S� I License Number
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