P - 78779REQUEST FOR ELECTRICAL INSPECTION
1��# ��- 917 � Minnesota Board of ElecVicily
. 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651)642-0800 RS 1-800-627-3529 www,electricitystate.mn.us
❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR Describe -us e the white copy if necessary - the w�ti�it Cpvered by this request:
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GENERAL FEES Outdoor Liahtina Standard � S7
3to12
IPOWER
0 Ampere
800 Amce
CIRCUITS OF LESS THAN 50 VOLTS
Ystem Device or Apparatus � $.50
ADDITIONS TO THE GENERAL I
350 Per Unit
Unit � $25
I IIII II III II III II III II III II III II 111 II III II � I�
14B39179
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service �dlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Tri{u Each Dwelling Unit �$80
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(minimum total fee is $20) 20 �
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I hereby certy Mat I inspecBed Ihe elacbical imi�laion desaibed herein an Me dabs �Eed:
:u uw�vnntc 1 rU IF NOT GoMPLETED WITHIN 12 Mi
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"w"°" 1010• Raiigh-in Inspection Required? ❑ Yes ❑ Np Irupedion Other Than Rcwgh-In: ❑Ready Now NAII Cail
�� 1103 You must call the inspectar when ready! Date Ready 1/ 1 l O 3
I certidy that I am 1he �ICENSED CONTRACTOR ❑ COA�IPANY ❑ OWNER and hereby request inspecUon of tl�e electrical work at:
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