P - 76632REQUEST FOR ELECTRICAL INSPECTION � �
2� U o�''A � 3 4� Minnesota Board of Electricity ,��-:
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-OS00 TTY/MRS 1-500-627-3529 www.electricity.state.mn.us
Describe -using the back of the �jte copy/'rf necessary - the work covered by this request:
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✓ICES I POWER SUPPLIES
0 to 400 Ampere na $25
I CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
3 to 12 Units @$50 Per Unit
Each AddRional Unit @ $25
OTHER ADDITIONAL FEES
Liphtina Retrofit (a� $.25 cer Fixlure
Trafic Siqnal Standard
ONE � TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Addftional Ins ion Tri s$20
Investi ative Fee
Reins ion Fee $20
TOTALFEE
(minimum total fee is $20) ���?� :
THIS AREA FOR INSPECTOR IISE ONLY
I hereby certify that I inspected me electrical installation described herein on the dates staled:
SeVarateBondin Ins ~ ionVV $20V ��'l2 � d�
S allnspection $30perHour e�r+eoi�anr�ooneo on�
S'al Ins ion $.31 r Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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�ace: Rou h-in Ins
g pection RequiredT ❑ Yes No Inspection Olher Than Rough-In: ❑ Ready Now ❑ Will Call
���1�/ (� You must rall the inspector when ready! Date Ready:
I cerMy that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at