P - 787231-416-834�
O NEW ❑ REMODE ADDITION ❑
� .
GENERALFEES
IMMUNICATION, REMOTE CANTROL,
CIRCUITS OF LESS THAN 50 VOLTS
3 M 12 Units �$50 Per
Each Additional Unit @ ;
REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity �
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TfY/MRS 1-800�27-3529 www•electricity.state.mn.us
R Describe�using the back of the white copy i necessary - the work covered by this request
r Liahtina Standard �D. $1
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes ihe Service �dlor Paxer Supply up to 500 Amperes, All
Cirouils and Two Inspection Trips Each Dwelling Unit �$80
TOTAL FEE D '�i
(minimum total fee is $20)
T1tl5 MEA Gpt �6PECTOR USE OILY
I hereby cer6fy tlwt I insp�ed tlie elechica� lnstalla6on described herein ai Me daBes stffied:
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Request Date: Rough-in tr�sPedion Required? ❑ No Inspedion Olher Then RauglNn: OReady Now VWII Call
���4 You must mll the inspedor wh� readyl Date R�dy. .
J cerMy that I am the �LICENSED CONTRACTOR ❑COMPANY ❑ OWNER and hereby request i�spection � Itl�e elecUical wwk at:
Job Site Address (Street Box. a Route No.1 _ Cilv i' _ ��8
0225 � �
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EB-00001M11 8A. 2002