The URL can be used to link to this page

P - 78010REQUEST FOR ELECTRICAL INSPECTION 1� 5 2 0- 915 � Minnesota Board of Electricity - 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 (651) 642-0800 TTY/MRS 1-800�27-3529 www.electricity.state.mn.us ❑ NEW O REMODEL ❑ ADDITION EPAIR Describe -using the back of the white copy if necessary - the work covered by this request: I POWER SUPPLIES ALARM, COMMUNICATION, REMOTE CONTROL, SIGI CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Each S stem Device or A aratus $.50 ADDITIONS TO THE GENERAL FEES MULTIFAMILY DWELLINGS PE 3 to 12 Units @$50 Per Unil Each Additional Unit @ $25 OTHER AC Li htin Rehofit $.25 er' Center Pivot Irri ation Boom Manufxtured Home Park Lc Recreational Vehicle Park Si FEES Mile \Y BE OR Fee @ 9 uDf01O f Transformer I Power Supply for Signs I Outline Lighting @ SS ONE 8 TWO FAMILY DWELLINGS, EACH UNIT Includes the Service andlor Power Supply up to 500 Amperes, All Circuits and Two Inspection Trips Each Dwelling Unit @$BO Additional Ins ection Tri s $20 Investigative Fee Reinscection Fee C� $20 TOTAL FEE I �'""� (minimum total fee is $20) 3j � rws,w�,FOairu�c.aausEO'a. ° I hereby certiry that I inspected the elec6ical installa6on described herein on ihe dates sWted: uF �(�� ) �� 6�� a 152�9158 ��G6��1 ,�i ,st� Request Dffie: Rough-in Inspection Required? ❑ Yes _ m No Inspedion O[her Than Rough-In: ❑Ready Now ; Will Call � 1 �d� Vou must call the inspecta when ready! �` Date Ready: I certi(y that I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at: Jab Site Address (Street, Box, or Route No.) _ City � Zip Code � \ / \ / ise N�unber Master Electricien a P � nse Number �� Phone (s) : 7 ., Ae/ � r % � INS �ON BACK OF YELLOW COPV� ARD ELECTRICITV CAPV EB-00001A-14 8.7. 2002 _ �_ `. . . . . . _�� .