P - 80088REQUEST FOR ELECTRICAL INSPECTION
,� �� V O- 5 5 4� Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
NEW 0 REMODEL ❑ ADDIjIQ,�J� O�P,Qf�,,,Qgscp�g,-4�10.t� �3Fk 9��.:N�ite copy if necessary - the work covered by this request:
GENERALFEES
IMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS OF LESS THAN 50 VOLTS
ADDITIONS TO
fIFAMILY DWELLINGS (PE',
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
Center Pivot Irtiaation Boom
Traffic Sional Standard
ONE & TWO FAMILY DWELLINGS, EACH UNIT
lodudes the Senice andlor Power Supply up to 50� Amperes, AA
Circuits and Two Inspection Trips Each Dwelling Unit @$80
(minimum total fee is $20) � 20,50
THISAREAFq21N5PE TIXtU5E0NLY
I hereby cerfiy that I inspected tlie electrical insfall�on described haein on the dates sm0ed:
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Request Dffie: Rough-in Inspection Required? ❑ Yes Inspection Other Than Rough-In: ❑ ady Now � VYII Call
a7��i� You must call the inspector wh� ready� Date Ready:
I certify that I am the �ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
INSTRUCTONB ON BACK OF YELLOW COPV 80ARD OF ELECTRICITV CAPY EB-0OOOtA-11 8.1. 2002