P - 76355REQUEST FOR ELECTRICAL INSPECTION � .� '
� � � �_�� � � � � Minnesota Board of Electricity
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.e[ectricity.state.mn.
-using the back of the white copy'rf necessary - the work covered by this request:
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GENERAL FEES Outdoor Li hting Standard �$1
SERVICES / POWER SUPPLIES Traffic Sianal Standard a(�. $5
401 to 600
Above 800
3, CIRCI� OF LESS THAN 50 VOLTS
� Sjrstem bevice or Apparahis @ $.50
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ADDRIONS TO THE GENERAL I
MILY DVNELLINGS (PER UNllj
12 Units (a� $50 Per Unit
Manufactured Home Park Lots (
Reraeatiorcal Vehide Park Sites
1LLATION MAY BE ORDERED
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20595393
ONE 8 TWO FAMILY DWELLINGS, EACH UNR Q
Includes the Service andlor Power Suppty up to 500 Amperes, All
ircuits and Two Inspectlon Trips Each Dwelling Unit @$80
Addfional Ins 'on Tri $2tl
Investi ative Fee
Reins on Fee @ $20 -
TOTALFEE
(minimum total fee is $20) �
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I hereby certify that I h�speded the el�triral InstaOetion desamed herein on Ne dafes ataGed:
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IF NOT COMPLETED WITHIN 12_M_ONTF
FOROFF�;CEUS�ONLY .
RECD APR 3 0 2�7
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��� �1 ` Rough-in Inspectlon Requir�l9 Yes ❑ No InspecUon Other Than Rough-In: ❑ Ready Now� Call
����r '� You must call the inspector when rea yl Date R�dy:
I certify that I am the CENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspe�ion oFthe electrical work at
Job Site Street Address City
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