P - 75976p� REQUEST FOR ELECTRICAL INSPECTION '
L� 0 2�° a� �� � Minnesota Board of Electricity
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
�� �') (651)642-0800TTY/MRS 1-800-627-3529 www.edecdricity.state.mn.trs
ribe -�sing th� �k o the Whit�O�ar�, - the wo co�ar� Iy this r� °1 A_"7 S��
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GENERAL FEES Outdoor Liphtinp Standard (a� $1
I SERVICES / POWER SUPPLIES
ALARM, COMMUNICATION,'REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
3 to 12 Units @$50 Pe
Each Additional Unit @
Fodure
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Illll �II! U!� IIIII II��I III� III� Iilll a� I��
20245056
6NE & TWO FAMILY DWELLINGS, EACH UNIT
Includ� the Service andlor Power Supply up to 500 Amperes, AII
Circuits and Two Ir�spection Trips Each Dwelling Unit @$80
Addfional Ins 'on Td $20
Imestigative Fee
Reir�s on F� $20
TOTAL FEE /j��
(minimum tatal fee is $20) ��
THIS AlffA FOR N6V ECf OR USE OMY
I hereby carUfy that I 6�ed tlre eleckiml insfallafion d� hereln on fhe detes smted:
rtou� w unre
FtlVAL WSPEf.TION �{s_ _' ." _ - ��LI �s,4��b
FOB OF^ICE llSE QMCr
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�� Rough-in Inspedion Requtr�? ❑ Y� �No Inspecdan Other Than Rough-In: ❑ Ready Now �W�7I Call
�—�� � V� You must call the inspector when readyl Date Ready.
I cefify thffi I am the�'LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby r�uest inspection of tlre electrical wrork at
Job Site Street Addr�s City
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Townshfp Secdon Range Fhe No. Couniy
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_ Ltcense Number
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