P - 781951-507-956 �
❑ NEW REMODE ❑ ADDITION ❑
GENERALFEES
SERVICES I POWER SUPPLIES
0 to 400 Amcere � S25
REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
1821 University Avenue Suite S-128, Sai� Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us
��U cribe -using the back of the ' copy 'rf necessary - the work covered by this request:
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Outdaor Li htin Standard $1
Traffic Sional Slandard O S5
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or ratus $.50
ADDITIONS TO THE GENERAL FEES
2 Units � $50 Per Unit
Addi6onal Unit @ $25
OTHER ADDITIO
ng Retrofit � $.25 per Fixlure
;r Pivot Irrigation Boom � $4(
factured Home Park Lofs �1$
ational Vehicle Park Sites �
Hour
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L5079569
0
� Transfortner I Power Supply for Signs I Outline LiqhGna $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspecfion Trips Each Dwelling Unit @$80
TOTAL FEE I v�C-� J
(minimum total fee is $20) ��
7HI5 AREA FOR INSPECiOR USE ONLY
I hereby certity Mat I inspecfed the electrical insfalla6on described herein on the dates sfated:
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PLETED WITHIN 12 MONTHS � �
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Roughin Inspection Required? Yes ❑ No InspecGon Other Than Rough-In: ❑Ready Now II Call
' O You must call the inspector when ready! Date Ready:
am the ��yICENSED CONTRACTOR ❑ COMPANY u OWNER and hereby request inspection of the electrical work at::
ss (Street, Box. �te .) City Zip Code
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BOARD OF ELECTRICT' COPV
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� License Number
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Phone (s)
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EB�00001A-14 8.1.2002