P - 78252REQUEST FOR ELECTRICAL INSPECTION
1� 4 71 �� 0 5� Minnesota Board of Electricity
1821 University Avenue Suite S-128, SaiM Paul, Minnesota 55104
� (651) 642-0800 T'fY/MRS 1-800�27-3529 www.electriciry.state.mn.us
❑ NEW EMODEI O ADDITION REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
GENERAL S Outdoor ' tin Standard S1
SERVICES / POWER SUPPLIES TraRc Sional Standard � 85 l ��
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S tem Device or atus $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 UniLs �$50 Per Unit
Each Addifional Unit @ $25
OTHER ADDITIONAL FE
L' htin Retrofit 5.25 r Fixture
Center Pivot Irri a6on Boom $40
Manufaclured Home Park Lots � E25
I THIS
I lill II III II III II Ili II il I II I II II III li III �� I�II
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes lhe Service aridlor Power Supply up to 500 Amperes, All
CircuiLs and Two Inspection Trips Each Dwelling Unit � E80
80
TOTAL FEE I �
(minimum total fee is $20) yQ
TMIS RREA FIXIINSPECTOR USE WY
I hereby cerfify thffi I inspecfed Ihe decb'ital insfaY�pn described herein on }he daRes s�0ed:
� �#.°?a 5 '�
14716054
�-�OO`� ` ���1b r�3t�� `�p,sv
Request Date: Rqigh�n Inspection Required? � No Inspedion Other Than RougMn: ❑Ready Now I Call
� i You must call the inspector wF�en ready! pate Read ,
Y
I certify that I am the �LICENSED CONTRACTOR ❑CONIPANY ❑ OWNER and hereby �equest nspecfion of the elechical work at;
�O y�nge � rse no. nty • - -
a
6l Please Provide Two (2) Phone Number(s) Induding N
/ � � / � /
Su Address
o �� v.
� Contrac�or License Number Master Electridan a Pawer LimiDed
uoense Mumoer
� /� ' 7
pany or Owner Perfarming nsfallation�
/K ��
idor. CamPe�Y a ' Irstellation) Phme (s)
/�v�� �
OF ELECTRICITV COPV EB-00001M11