P - 78965REQUEST FOR ELECTRICAL INSPECTION
1� 6 6 6- 2 5 6� Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
��j„ t� (651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
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❑ NEW REA�pEL� ❑ AD� ION� E�JPA� � escribe -using� �ack� � h�lopy i� essary� work covered by this request:
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Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
CIRCUITS OF LESS THAN 50 VOLTS
ADDITIONS TO THE GENERAL FEES Reins tion Fee $20
WELLINGS PER UNI TOTAL FEE
s@$50 Per Unit (minimum tofal fee is $20) .QQ
>n21 Unit (a7, $25 rws a�, Foa iruvecrae usE aur
I hereby certify Mat I inspecled the eVecbic� installation described herein on the d�es sta�d:
OTHER ADDITIONAL FEES _ �va � �O ( � `f `�
Hour
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Request Date: , Rough-in Inspection Required? ❑ Yes No Inspection Other Than Rough-In: �Ready Now Will Call
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-�o�- � j� You must call the inspector when readyl Date Ready.
I certify that I am the �ICENSED CONTRACTOR ❑COMPANY 0 OWNER and hereby request inspection of fhe electrical work at: