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P - 77280---- REQUEST FOR ELECTRICAL INSPECTION ��� 1�-14 5� Minnesota Board pf ElecViciiy 1821 University Avenue Suite S-128, Sairrt Paul, Minnesota 55104 (651) 642-0800 TTY/MRS 1-800�27-3529 www.electricity.stafe.mn.us 0 NEW ❑ REMODEL ❑ ADDITION REPAIR Describe -using the back of the white copy if necessary - the work covered by this request: �u� `�,� .�( ti 2 GENERAL /ICES I POWER 0 to 400 Amcere 0 to 200 Am re $5 Above 200 Am re $10 ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Each S stem Device or ratus $.50 ADDITIONS TO THE GENERAL FEES Z Units � $50 Per Unit Additional Unit � S25 25 per Fi�Aure i Boom @ ¢W Park Lots E Park Sites � ; ���� ����� ����� ����� ����� ����� ����� ����� �� �� L5761455 Outdoor 10KVA(a�$10 ONE 8 TWO FAMILY DWELLINGS, EACH UNIT Includes the Service andlor Power Supply up to 500 Amperes, All Grcuits and Two Inspection Trips Exh Dwelling Unit @ S80 Additional Inspection Trips �D $20 InvesGgative Fee Reinsoection Fce Ca1 S20 J � (minimum total fee is $20) — TH6 ARFA FOR IILSPECTqi USE p1Y � �1Hl� �� � IIISOEC� dIE �IC2� III5�011 dEStfl� �1lfelll 011 tl1E � 5�: z�2 ,���,5 - c,c��s�,, ��e: Raugh-in Inspection Required? ❑ Yes �,(Jo Inspedion Other Than Ragh-In: ❑Ready Now Wfll Call rZ ���� You must call the inspector when readyl Date Ready: I cefiy Uiat I am the ICENSED CONTRACTOR ❑ COA�ANY ❑ OVIMER and hereby request inspection of the electrical work at: