P - 76086�:,�.s� � � � � REQUEST FOR ELE �RICAL INSPECTION �
� � Minnesota Board of Electric ��
'� 9821 Universiiy Avenue Suite S-128, Saint Paul, Minnesota 55104 -�'
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.sdate.mn.us
-using e the whRe copy ff necessary - the work covere�i by this request: ^ s���
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GENE�IL fEES Outdoor Liphting Standard (� $1
401 to 800
Ahove 8(}0
:UITS I FEI
CIRCUITS OF LESS THAN 50 VOLTS
3 to 12 Units @$50 Per Unit
Each Addfional Unit @ $25
OTHER ADDRI01
Liahtir�q Retrofit aC}. $.25 oer Fixture
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I IIII II III II I�I II I�I II ��I II � U� u UI �� I�
198�7726
ONE 8'f WO FAMILY DWELLINGS, EACH UNff
Includes the Service arM/or Power Suppty up to 500 Amperes, FJI
Cimuits and Two Irtspecbon Trips Eac�h DwelGng Unit @$80
Addfional Ins�ction Tri $20
Invesfigative Fee
Reins 'on Fee $ZO
TOTALFEE �'
(minimum total fee is $20) �o�.p�
THISNffAFOR4�PEC(IXtUSE Y
I hereby.ceNfy that I mspeded-the electrlcal 6�ste0atlnn des�ibed herehron the dafas stated:
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�NNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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��� I�ough-in Inspectlon Required? �Yes ❑ No I�pe�lon Otlier Than Rough-1rr. � Ready Now � WiIFCaiI
�� ��Y6 0� You must call the inspector when readyl Date Ready:
I cefify that I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request ins�dion of the electrical wark at
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Ovmer/OccupantName Please Provide Two (2 Phone Numbers Including Area Cade
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