P - 75693REQUEST FOR ELECTRICAL INSPECTION '
�—� ��� 11 �� Minnesota Board of Electricity
1821 University Avenue Suite S-128, Sairrt Paul, Minnesota 55104
� , (651) 642-0800 TTY/MRS 1-800-627-3529 www.elecri-icity.state.mn.us � "�
D�scdbe -using the back of the white copy'rf necessary� - the work coveraJ by this requ�st:
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GENERAL FEES Outd�r Lighting Standard @$1
SERVICES / POVdER SUPPLIES Traffic Sianal Standard (� $5
0 to
CIRCUITS OF LESS THAN 50 VOLTS
iystem Device or Apparatus @ $.50
ADDRIONS TO THE GENERAL
ILY DWELLINGS (PER UNIn
! Units na. $50 Per Unit
FEES
Hour
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ONE & TWO FAMILY DIMELLINGS, FJ1CH UNIT
Inciudes the Service and/or Power Suppiy up to 500 Am�res, All
Circuits and Two Inspectlon Trips Eech Dwelling Unit @$80
Additional Inspedion Trips @ $20
Irnestluative F�
total fee is $20) � � c��'
I herebY �titY tlrat I m� tlre etedrical insta0adon descvibed here6i on tlre da�a etafed: �
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��� Rough-In Insp�tion Requtred7 ❑ Yes � InspecUon Ofher Than Rough-In: 0 Ready Now�fll Call
�—� �� You must call the i�pedor when readyl Date Ready. J
I certiifyy tlrat I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
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Me01ng Addres
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pr. Com�nv or Owner Perfortnir�t
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Contractor License Number Mester Electridan or Power
Lkk�nse Number
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Please Pravide Two (2) Phone Numbe�s incluc
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