P - 762691��-� 511 � �EQI�EST FOR ELECTRICAL INSPECTION
� � � Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
" . (651) 642-0800 TTY/MRS 1-800-627-3529 www.edectricity.state.mtt.us
II� -using the back of the white copy 'rf necessary - the work covered by this request:
E;�:GEL E6dEfi��Y S�lk'EFi '� Slt� � TGH
GIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL I
MULTIFAMILY DNIELLINGS PER UNI
' 3 to 12 Units @$50 Per Unft
�ach Additlonai llnit @ $25
� OTHER ADDITIONAL FEES
Lighting Retrofit @ $25 r Fbcture
Genter Pivot kri a6on Boom @$40
A9anufactured Home Park Lots $25
Recreational Vehicle Park Sites $5
S arate Bond' Ins on $20
Speclal Inspecction @ $30 per Hour
S ial Ins 'on $.31 �r Mile
THi$ IAISTAI,LATION MAY BE ORO
I�1ef ll�l lll� ll� lll� a� ��l�l� �l
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ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additionallns ecGon Tri�s @ $20
Investigative Fee
Reinspection Fee @ $20
TOTAL FEE
(minimum total fee is $201 �0= ��
that I inspected the electrical insfallatlon d�cribed herein on the dat� stat�:
�
D_IF NOT COMPLETED WITHIN 12 MON'
REC'D J U N 14 2007------
�007-C�952�
Rough-in Inspection Required7 ❑ Yes ��] No Inspection Other Than Rough-In: �Ready Now OWill Call
� i�. �. % vE!' You must call the inspector when ready� Date Reatly
I certify that I am the l�7 LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and harahv ranuccr i���e,.r;.... ,.�.ti....�.....:__�..._�. _.