P - 75699��1 �� 3 4� REQUEST FOR ELECTRICAL INSPECTION
o �� 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.edectrfcity.state.mn.us
Describe -using the t�ck oF the whRe copy if necessary - the work �ver� by this request:
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GENERAL FEES Outdoor Li htin Standard @$7
SERVICES / POWER SUPPLIES Traflic Signal Standard $5
0 to 400 Amaere an. $25 Supplemenfal Fee �$20
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Pawer Suppty up to 500 Amper�, All
Circadts and Two Inspection Trips Each DwelGr�g Unit @$80
CIRCUITS OF LESS THAN 50 VOLTS
3ystem Device or Apparaws @ $.50
ADDITIONS TO THE GENERAL I
Home Park Lots
S�ecfal Ins ectlon $30 er Hour
S�Clal Ins ' n@$.31 r MUe
THIS INSTALLATION MAY BE ORDERED I
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21176342
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tatal fee is
I i�rspected the electriml U�➢aUon des�ed herein on tlm dates s�ed:
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° NOT COMPLETED WITHIN 12 MONTHS ��_�
FOR 6FFICE USE ONLY ���✓"g� `'i�
I�C'D JUN - 6 2007
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�: Rough-in Inspecdon Required9 �Y� ❑ No Inspedion Other Tf�n Rough-In: � Ready Now� Cetl
�-���� You must call the I�pector when readyl Date Ready.
I cefify tMat d am ttre �ICENSED CONTRACTOR ❑ COMPi4NX � OWNER ' and hereby request insp�ion of the electrical work at
Job Site Street Address �� City !_ //(� /�
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Trnmship Sedlon Range Ftre No. County
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pwngr)Ocw '� Please P[odde Two (2) Pho�re Numbe�s Im�uudMg Area Code
� l�t � IS �f U Q� P.r" ((o!Z) 325- 7S3/� i)
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