P - 78087REQUEST FOR ELECTRICAL INSPECTION
1� J� 1- 9 41 � Minnesota Board of ElecUicity
1821 Universiry Avenue Suite S-128, Saint Paul, Minnesota 55104
° (651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
C� N MODE 0 ADDITION Cj R�FpAiR Describe -using theJ�a�c of ihe white copy if necessary - the work covered by this request:
' � Above 200 Ampere �$10
ALARM, COMMUNICATION, REMOTE CONTROL,
GRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aooaratus � E.50
VI11i
(� 5.31 per Mile I
TION MAY BE ORDERED
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15079411
Outdoor L' hfin Standard $1
Traific S' nal Standard $5
Su ment� Fce $20
Transformers u to 10 KVA $10
Transfortners over 10 KVA $ 20
Transfortner I Power Su I for Si ns I OuBine Li htin S5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$60
Additional Ins tion Tri $20
Investi ative Fee
Reins tion Fee $2p �
TOTALFEE
(minimum total fee is $20) ,,�p
,MS,VIEA fOR �ISPE�.OR USE «l.
I hereby certiry th� I inspecled the electrical installa6on described herein on the dates staled:
RIX1GH N1 (�pAT.,E
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fl�MllSPECiqN � pATE
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FJfPWED/�91MONED pATE
iCTED IF NOT COMPLETED WITHIN 12 MONTHS
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Requesc ce: Rough-in Inspection Required? es ❑ No Ins
peGion Other Than Rough-In: ❑Ready Now Vlhll Call
/ 30 b3 You must wll the inspector wh� ready! pe�e �Y
I ' 1Fk�t I m tl�e �LICENSED CONTRACTOR ❑COMPANY ❑ OWNER and hereby request inspec,•tion of the e�ectriql work at:
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EB-00001M74 Q1.I002