P - 78169REQUEST FOR ELECTRICAL INSPECTION
'�� J��- 7 3 4� Minnesota Board of Electricity
1821 University Avenue Suite S-128, SaiM Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
❑��^ O �REMODEL ❑ ADDITION EPAIR Describe -using the b�` of�t�he w�ite copy'rf necessary - the wak cte�r by ihis request:
�..� Vt �11C�..?_� ��L 4'��i YC_� ' � 1C�(� �^ �,�L ��L.l..�
401 to 800
i I 0 to 200 Amcere (aD $5
� Above 200 Ampere $10
ALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aooaratus � S.SD
S50 Per Unit
Unif @ S25
Boom �
'ark Lots
5 ial Ins fion $30 r Hour
Speci� Inspection @ $.31 per Mile
THIS INSTALLATION MAY BE ORDERED I
Traffic Signal Standard
Supplement� Fee @ S
Transfortners uo to 10
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, Ali
Circuits and Two Inspeclion Trips Each Dwelling Unit �$60
( TOTAL FE; I �/ , S�
minimum total fee is $20 —^� � {o
THISAREA Fpt WSPECTCR USE 0lLY
I hereby ceAify that I inspected the ekcOrical install�on described herein on the da0es stahed:
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12
IIIIIIIIIIN�IUI���IUI��INII�N�I� �� ��/
15797343
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Request �: Rough-in �nspecfion Required? ❑ Yes Irapedion Otlier Than n: y Now O Will Call
�� You must call the inspecta wlien ready! Date Ready: � 1�� �
I certiy tliat I am the �ENSED CONTRACTOR ❑COA�ANY ❑ OWNER and he�eby �equest inspeciion of the electrical work at:
E6-0OOO1M4 8.1.2002