P - 79754p REQUEST FOR ELECTRICAL INSPECTION
1 ,4 01 � O o� � Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paut, Minnesota 55104
'� (651) 642-0800 TTY/MRS 1-800-627-3529 www,electriciry.state.mn.us
❑ NEW ❑ REMODEL ❑ ADDITION ❑ AIR D ribe -using e back of the white copy if necessary - the work covered by this request:
�•
GENERAI FEES Outdoor Ligh6n Standard $1
SERVICES / PC
0 to 400 Ai
401 to 800
Above 800
CIRCUITS / FEI
IALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Apparatus @$.50
to 7
r�c
to 10
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes ihe Service andlor Power Supply up to 5D0 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additioaal lnspection Trips $z�
Investiaa6ve Fee
_LINGS PER UNIT TOTAL FEE I �O'�
$50 Per Unit (minimum total fee is $20)
Unlf �$2S *ws naEn Fon navecroa use aar
I hereby cer6(y that I inspected Me elec6ic� instaN�on described herein on tl�e dates sta�d:
OTHER ADDITIONAL FEES /.( /.( , • / � � � ' � 3
I IIII I) III I� I�� II III II II� �I I�I II ��I II I�� �� ��
14018071
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Request Date: Rough�n Inspection Required? ❑ Yes ❑ No Inspedion Other Than Rough- . Now ❑ Will Call
lp� /4 • O� You must call the inspector when ready! Date Ready: ,
1 certiy that I am th EN ED CONTRACTOR ❑COW�ANY ❑ OWNER and he2by request inspection of the electricai work at:
Job Site� dr�s (Street, Box. or e No.) C' _^ Zp Code �
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7l o� „i/�.1�/
Sed'wn Township Fire No. Coun
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619 Coon RaPid: Blvd. NW
INBiRUCTONS ON BACK OF YEtJe�l � BOARD OF ELECTRICIlV CAPY
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E&00001M14 . 8.7.2002