P - 78376REQUEST FOR ELECTRICAL INSPECTION
_1 ��, 9�� 8 7 3 � Minnesota Board of ElecVicity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
. ���� (651)642-0800TTY/MRS1-800�27-3529www.electricitystate.mn.us
O NEW REMODEL ❑ ADDITION 0 REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
/�lY,C%CL�SL� 6s1,%%i�%Si�S
40, ta 800
Above 800
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or ffius $.50
ADDITIONS TO THE GENERAL FEES
Transformers uo to 10
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Grcuits and Two Inspecfion Trips Each Dwelling Unit �$80
Additional Inspection Trips � $20
Investigative Fee
Reinscection Fee � 820
���rLLr�c
(minimum total fee � $20) �
TIkS /JIFA Fpt INSPECTORUSE Ulv
I hereby cerUy Mat I inspected the electrical instaAafon desaibed herein on the dafes sf�ed:
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I IIII II III (I III II �II II III II I�I II (I� I� III II � I�
1 4 9 7 8 7 3 8 ���-`�u�� °cvr ��
Request Date: Rough-in Inspection Required? ❑ Yes Inspedion Other Than Rough-In: �Ready Now I Call
� i� i0 � You must call the inspector when ready! Date Ready:
I certify that I am tt�e �CICENSED CONTRACTOR ❑ COMPANY ❑ OWNER arb hereby request inspection of ttie electrical work at:
IN8TRUC nM18 ON BACK OF YELLOW COPY BOARD OF ELECTRICT' COPY E&00001M14 8.1. 2W2