P - 76013REQUEST FOR ELECTRICAL INSPECTION ��•'
1 � � � � � � � 9 � Minnesota Board of Electricity
1821 University Avenue Suke S-128, SaiM Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us �" ''
Describe -using the backof the arhfte copy'rf necessary - the work covered by this request:
` _�i r /7 / !
Above 200 Am ere a$10
ALARM, COMMUNICATION, REMOTE COMROL, SIGNALI
CIRCURS, CIRCUITS OF LESS THAN 50 VOLTS
Each S em Device or Ap ratus $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UN
3 to 12 Units @$50 Per Unit
Each Addfional Unit @ $25
OTHER ADDITIONAL FEES
Lighdng Retrofit @ $25 r Fodure
Center PNot Irrigation Boom @ $40
Manufactur� Home Park Lots $25
Reaeabonal Vehicle Park Sites $5
Se Bornfin Ins 'on $20
S IlnspecUon @ $30 �rHour
S al Inspa.fion $.37 r Mile
THIS INSTALLATION MAY BE ORDERED
I�II �� �� ��� �� �I� �� ��� �� ��� � �0 �i �� 0� ��
19911197
Standard
I Transfortner / Power Supply for Signs / Outline Lighting @$5
ONE 8 TWO FAMILY DWELLINGS, EACH UNR
Includes the Service and/or Power Supply up to 500 Amperes, M
Circuits and Two Inspection Trips Each Dwelling Unit @$BO
Addfional Insaection Trios (aD $20
total fee is $20) �� � Q � �
I here6y �rtHy that I fhe electrial inslallaUon desaibed herein on fhe dates sta�d:
aawx m onre
--�.�.. ^2 -�— �� :
FwuwsaEaiau , � ����
�=.
owu�n�aermmo oatF
ECTEDJF NOT COMPLETED WITHIN 12 MONTHS
r:�F c,rFic� u7c �.��!�v �
�-3�Y
� � ������
�
��
Rough-in Insp�tlon Required? �Yes ❑ No Inspecdon Other Than Rough-In: ❑ Ready Now �Nid Call
����D� � �`Y Y� C\
You must call the ins r when read I Date Read
i certiFy that I am the�LICENSED COIdTRACTOR O COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Site Street Addr�s C�y
// I °�� �f' � _ �� . _ AA� � „ ] / _
�
nr/��� Electric Inc�
RiY@i,
��
'- ���' )
Master Electridan or Power Limf[ed �
Licer�se Number
ro (2) Phorre Numbers IrMJudirm Area