P - 80602REQUEST FOR ELECTRICAL INSPECTION ��
1 14 5 0 91 �innesota Board of Electricity
� � 7821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-SOo-6273 9
//�/�� www.electricity.state.mn.us �ZC�Z�
I DNEW �REMODE� ❑ADDI710N ❑REPAIP t'Y�/7 I �I/)IJY)Y ) �D�l— / / I—
e�$70 v Inclutles the Service anNor Power Supply up to 500 Amperes, All
TION, REMOTE CONTROL, SIGNALING CircuAS antl Two Inspection Tnps Each Dwelling Unit �$8(
OF LESS THAN 50 VOLTS Atltlitional Ins ection Trips � 520
ce or A raNS B 5.50 Investi ative Fee
'IONS TO THE GENERAL FEES Reins ectian Fee � S20 �
INGS PER UNtT TOTAL FEf
5o Per unB (minimum total fee is $20
�It � $25 A��Pd,w�sErn�.
'/ ^
]THER AODITIONAL FEES �yr� ���%' "/ 2 9 p 7�', I
� $25 r Future � -
fion Boom � $49
�P Park I Mc � A�.S I here�vi ce.niN tMal I ir�soaled �he eleclnral irisallation descnbetl herein on Ihe
` FOR OFFICE USE ONLY
(If�l�Ik��I�fI�I��Ii�1�I�II1�I��ft�I��I�l�lll�� �o,s�'a`�9i� �90 i v
Requ Date: J7 % Rough-in inspectim Requiretl? ❑ Yes No Inspection 01her Then flough-In: ❑ Ready Nmv Will Call
���I.� I Vou must call t�e inspaclw when reatlyl De[e Reatly:
I ce�tify that I am ihe LICENSED COMRACTOR ❑ COMPANY ❑ OWNER and hereby request inspectlon of ihe electncal work at:
,bb Atltlress (StreH, Box, or Route No.) City Zip Cotle
1/;�.� t�vrr���l� 1�� �2d �T� l a.� �S�f3z
� Occupant
',� INC. contractor �icense
N.E, �ni.�
I '1 %rc� (il/�'����'i' I7Lo3 757-��ZD7� I
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