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P - 78204REQUEST FOR ELECTRICAL INSPECTION �� - 5 2 3- 7 6 4❑7 Minnesota Board of Electricity 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 (651)642-0800TTY/MRS 7-800-627-3529 www.electricity.state.mn.us ❑ NEW REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of fhe white copy if necessary - the work covered by this request: � i n0 C�Y s GENERAL FEES Outdoor Liahfina Standard (aD St SERVICES / tM, COMMUNICATION, REMOTE CONTROL, SIGNALING UITS, CIRCUITS OF LESS THAN 50 VOLTS Each System Device or Apparatus @$.90 ADDITIONS TO THE GENERAL FEES fIFAMILY DWELLINGS PER UNI 3 to 12 Units @$50 Per Unil Each Additional Unit @ $25 FEES Ligh6ng Rehofit @ E.25 per fixtuie Center Pivot Irtiaation Boom � $4( Traffic Signal Standard Supplemental Fee @ $ Transformers up to 10 i Transformers over 10 P ONE 8 TWO FAMILY DWELLINGS, EACH UNIT Includes ihe Service andlor Power Supply up to 500 Amperes, All CircuiGs and Two Inspec6on Trips Each Dwelling Unit @$BO TOTAL FEE I ,�}� (minimum total fee is $20) ��, J V rws �a�n Foa irue�craR usE aar I hereby ceN(y that I inspected the electrical installa6on described herein on the dates 5ta0ed: �. �� � � {O p2 � Illll�lll���rlll�lll�lll��������lll�l�l����� Q� c��� 15237647 . �O`� rcequesc ua�e: Rough-in Inspection Required? ❑ Yes ��lo Ins �, � 1 ,, � pecUOn Other Than Rough-In: ❑Ready Now Will Call � V You must call the inspector when ready! Date Ready: I certify ihat I am ihe f�LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of ihe electrical work at::