P - 79229REQUEST FOR ELECTRICAL INSPECTION
�`���- 5 6 0 Q Minnesota Board of Electriciry
1821 University Avenue 5uite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 lT'/M RS 1-800-627-3529 www. elec[ricity.state. mn. us
NEW D REMODEL ❑ ADDITION _ O REPAIR _Describe_ usingthe back of the white copy if necessary - the work covered by this request:
0 to 400 Ar
401 to B00
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
TO
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
Outdoor Liohtina Standard
� Transfortner I Power Supply for Signs I Outline Ligh6ng p$5
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 �$80
(minimum total fee is $20) � �LI.fiO
THIS AREA fqt iNSPECTOR USE OMr
I hereby certify thffi I inspecled tlie electrical install�on descnbed herein on the dates sla0etl:
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Request �ate: I Rough-in Inspection Required? ❑ Yes ❑'No Inspection Other Than Rough-In: Okeady Now ❑ VYdI Call
����� You must wll the inspecta when ready! Date Ready:
1 certify that ! am the �CICENSED CONTRACTOR D COA4PANY 0 OWNER and hereby riequest inspection of the electrical work aT.:
IN37RUCTONS ON BAGK OF VELLOYY COPY BOARD OF ELECTRICITV COPV EB-00007M74 8.1. 2002