P - 75697REQUEST FOR ELECTRICAL INSPECTION �°;
2��,�7 �� 3� � Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minn�ota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
D�saibe -using the back of the white copy'rf necessary - the xrork covered by this requ ��l ���� � �_� �� ���
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I SERVICES /
�UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL I
Cerder Pivot Irtigatioi
Manufactured Home
RecreaUonal Vehic�e
Hour
FEES
1 THIS INSTALLATION MAY BE ORDERED
0
ONE & TWO FAMILY DFNELLINGS, EAGN UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Ir�s�cUon Trips Each Dwelting Unit @$BO
AddiGonal Inspection Tdps @ $20
InvestiqaUve Fee
TOTAL FEE /j � �p
total fee IS $20) 7
I irispeded fhe electriwl installatlon descn'bed herein on the dates atat�:
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IF NOT
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��� Rough-in Inspectlon Required? �s ❑ No Inspectlon Other Than Rough In: � Ready Now CaII
���—� � You must call the imspector when readyl Date Ready:
I certiiy that l am the �ICENSED CONTRACTOR � COMPANY ❑ OVNNER and hereby request inspection of the electrical work at
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