P - 76178REQUEST FOR ELECTRICAL INSPECTION
2 0 0 6 2°� 12 � Minnesota Board of Electricity I
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
� � � (651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
ing the ba f e ut�4ite copy'rf necessary - the work covered by this request: ���
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G NERAL FEES Outd�r Lighhting Startdard @$1 _
0 to 400
ALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A �paratus @$.50
ADDITIONS TO THE GENERAL I
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CeMer Pnrot I�igaUon Boom @
Manufactured Home Park Lots
I I�I II III II �u ��II � III II III II lu U W�� I�
20628129
20
ONE & T1N0 FAMILY DWEWNGS, EACH UNIT
Includes the Service and/or Powrer Supply up to 500 Amperes, NI
Circuits and Two InspecUon Trips Each Dwelfing Unit @$80
Additional Ins 'on Tri $20
Irn�fi ative F�
Reins ' n Fee $20
TOTAL FEE /��'
(minimum total fe� is $20) 0C
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I hereby ceAdy tlmt I tr�peded tlre etechical i�tallaUon d� Irerehi on the dates s�ted:
=0R OrF>CE Uk Gt>Lr
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�� Rough-in I�pection Requir�ll ❑Yes �No Inspection OtherThan Rough-In: � Ready
� � You must cell the inspector when ready! Dahe Ready:
I certify that I am the CENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request ins�Ction of tF
Job Site Street Address Ci1Y
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T p Sectlon Range Flre No. Cou �
OwnedOxupant Name 1 Please Provide Two (2) Phone Idumbe�s
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MRl 55304
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Master Electricfan or
Li�nae Number
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electrical work at