P - 79006REQUEST FOR ELECTRICAL INSPECTION
1�6 4�- 6 3 2�2 Minnesota Board of Electricity _
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55704
(651) 642-0800 TTY/MRS 1-800-627-3529 wwiv.electriciry.state.mn.us '
❑ NEW ❑ REMODEL ❑ ADDI7IQ REPAIR cribe - i back of the while copy if necessary - the work covered by this request:
0 to 400 Ampere @ $25
401 to 800 Amcere p$
CIRCUITS, CIRCUITS OF LESS THAN SO VOLTS
Each S stem Device or A aratus $.50
ADDiTIONS TO THE GENER4L FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units C� $50 Per Unit
Includes ihe Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$8Q
( iOTAL FE j I ��
minimum total fee is $20
.ws u�n caemsr�c,op us� orav —
I hereby certiy that I inspected the electric� insfallation descnbed he.rein on the dales sfa0ed:
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Req Date: Rough-in Inspection Required? ❑ Yes ❑ No Inspedion Other Than Rough-In: dy Now C� Vlfill Call .
��O �O You must caN tfie inspecta when r�dy! Date Ready.
I ceRify tliat I am ttie ICENSED CONTRACTOR ❑ COMPANY � OWNER and hereby �eq�st inspection of the electrip{ work at:
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INSTtUCTONE ON BACK OF
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BOARD OF ELECTRICT' COPV
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�se Number Master Eiectridan ar Power Lir
. w ..� � License Number /� Aw /i
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E&00001M14 8.1.2002