P - 76986REQUEST FOR ELECTRICAL INSPECTION
2���} o�(LC o Minnesota Board of Electriaty
1 J 1821 University Avenue Suite 5128, Saint Paul, Minnesota 55104
•°`"���� • (651)642-0800TTYIMRSI-800-627-3529www.electricity.state.mn.us
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CIRCUITS OF LESS THAN 50 VOLTS
iystem Device or Apparatus (d� $.50
ADDITIONS TO THE GENERAL FEES
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THIS INSTAttATION MAY BE ORDERED DI.
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Fee
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Indudes the Service andlar Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unft �$80
TOTALFEE ,
total fee is $201 � s'Z?
� nerenvi ceAifv thet I insoeded the ekctrical :istalla6on desa�ed nerein on tlie dates sta�d: I
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ED IF NOT COMPLETED WITHIN 12 MONTHS
*"JR OF=ICE UsC ON:;�`
RECD SEP �5 2007
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�� Rough-in Inspectlon Required? ❑Yes �NO Inspecdon Otl�er Tha� RougMn:�R�dy Now OWi� CaH
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y / You must caN fhe inapector when ready! Dale Ready.
I certify that I am the LICENSED CONTRACTOR �7 COMPANY ❑ OVIMER and hereby request inspectia� d the elecd�ical wak at
Job Site Street Address City `�
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Pleaae ProtiWe Two (2) Phone Numbers Indudirg Area Code
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or, Company or Owner Perfortning Insteqation)
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ontrada or Performing InstallaGon Please Provide Two (2) Plwne Numbers Inc
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F YELLOW COGY BOARD OF ELECTRICITV COPV E�.