P - 78676(� REQUEST FOR ELECTRICAL INSPECTION
1— 4 4, U°�. �� � Minnesota Board of Electricity -
. 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 :- '
��[ ����� (651) 642-0800 TTY/MRS 1-800-627-3529 www.electricirystate.mn.us """'"
❑ NEW REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
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GENERAL FEES Outdoor Ligh6ng Standard @$1
SERVICES / POWER SUPPLIES Traffic Sianal StandaM C� $5 �
ALARM,
CIRCUITS OF LESS THAN 50 VOLTS
iystem Device or Appazatus � $.50
ADDITIONS TO THE GENERAL FEES
3 to 12 Units � S50 Per Unit
Each Addi6onal Unit � $25
HOUf
Mile
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Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
TOTALFEE h /�
(minimum total fee is $20) p( S��v
THIS AREA Fdi IiISPECTqY USE OKY
I M1ereby cerUty that I inspected the electricai insfalla6on described herein on ttie d�es staBed:
WITHIN 12
_. _ _ _
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AG�i.�
Reques� vace: Rpugh-in Inspedion Required7 Lf Yes L� No Inspedipn pther Than Rough-In: ❑Ready Now �VVVNI Call
�—�� Q� You must call the inspector when readyl Date Ready.
I certity ihat I am tt�e �ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby req�st mspection of tlie electrical wak at: