P - 78051l/ SU�i� REQUEST FOR ELECTRICAL INSPECTION
1 5 3 i— 1�� � Minnesota Board of ElecVicity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651)642-0800TTY/MRS 1-800�27-3529 www.electricity.state.mn.us
0 NEW REMODEL ❑ ADD,I/T�ION ❑ REPAIR Describe -using the back of the white copy rf necessary - the work covered by this request:
' 1'�/ h�(lw I/SrYI L. S�i %%%� �'liir 5
0 to 400
401 to 8
j Above 200 Ampere �$10 '
AIARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
3 to 12 Units @$50 Per Unit
Each Addi6onal Unit @ $25
Pivot imgation Boom @ $4(
ctured Home Park Lots ;
Gonal Vehicle Park Sites
te Bonding Inspec6on @
Insoec6on (aD $30 cer Hour
Traffic Si�nal Standard
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Txro Inspec6on Trips Each Dwelling Unit @ S80
( TOTAL FE j I G�`v
minimum total fee is $20
iH15 MEA Fpi INSPECiOR USE OfYY
I hereby ceAify that 1 inspecled the electrical insWla6on described herein on the dafes staled:
Z
� TIi15 INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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Request Date: Rough-i� Inspection Required? � Yes Inspedion Other Than Rough-In: OReady Naw Will Cali
fv—�/iu3 You must call the inspector when ready! Date Ready:
I certity that I am the �CENSED CONTRACTOR u COMPANY ❑ OWNER and hereby request inspection of the electrical work at: