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P - 79206REQUEST FOR ELECTRICAL INSPECTION -= � ��` � C? �- 5 2 6� Minnesota Board of Electricity - : 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 (651) 642-0800 T1Y/MRS 1-500-627-3529 www.electricirystate.mn.us NEW ❑ REMODEL ❑ ADDITIQeEL X SERVICES 1 I 0 to 400 ALARM, COMMUNICATION, REMOTE CONTROI CIRCUITS, CIRCUITS OF LESS TNAN 50 VOLTS Each System Device or Apparatus @ 8.50 ADDITIONS TO THE GENERAL � Descnbg u�g,thgb�ck of„�hg,white copy if necessary - the work covered by this request: Outdoor ONE & TWO FAMILY DWELLINGS, EACH UNI7 Includes the Senice andlor Power Supply up to 500 Amperes, All Circuits and Two Inspection Trips Each Dwelling Unit �$80 s to 12 Units @$50 Per Unit (minimum total fee is $20) I 2Q•�0 Each Additional Unit @$z5 rNis nnEn coa iraaECTOa usE orar I herCby cer6y that I inspecMd Me electrical installa6on described Aerein on tlie dates staled: OTHER ADDITIONAL FEES Li htin Retrofit $.25 r Fixture Center Pivot Irti ation Boom $40 R01�"'" °A E Manufxtured Home Park Lots $25 Recreational Vehicle Park Sites $5 F�wa ws�cr�a, / !/w e Se arate Bondin Ins tion $20 `� �`" �� � S ial Ins tion $30 r Hour �0' °"TE S ial lns tion $.31 r Mile S INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTiiS ' llll (l lll !I III I I III N lII II IiJ ll l� 111i1 li � l llll R4699 17685Zk�4 ��� �D� • d� ��� Request Dffie: Rough-in Inspection Required7 ❑ Yes ❑`Wo Inspedion Other Tha� Rough-In: ❑Ready Now G Will Call Q7�� You must call the inspedor when ready! Date Ready: I certify fhat I am the �iCENSED CONTRACTOR ❑CORAPANY ❑ OWNFR and hereby request inspection of tl�e electrical work at: INSTRUCTONS ON BACK OF YELLOW COPY BOAR� OF ELECTRICITV COPY EB-OOOOlA-14 8.1. 2002