P - 78694REQUEST FOR ELECTRICAL INSPECTION
1� 4 31 �� O� � Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
' (651) 642-0800 TlY/MRS 1-800-627-3529 www.e[ectricity.state.mn.us
.r
❑ NEW ❑ REMODEL 0 ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - theyvork covered by this request:
� . • � .`�. . J 1 _ e w _ �
GENERALFEES
ALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatu
ADDITIONS TO THE
fIFAMILYDWELLINGS (PERUI
3 to 12 Units �$50 Pw Unit
Center Pivot Irti9ation Boom
( I��I II �II II III I) (I� �� III (I (II II �II �I III �� I�
14312086
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Cireuits and Two Inspection Trips Each Dwelling Unit @$80
(minimum total fee is $20) � �
THIS AREA FOR INSPECTdi USE ONLY
I hereby cerUfy tl�at I inspected tlie electrical installa6on described
�� (S`�—�
� �aa�a
� S�
�i�e:_� � Rough�n Inspection Required? ❑ Yes �No Inspection Other Than Rough-In: �Ready Now U VJII Call
JYou musl call the inspeclor when ready! Date Ready:
I certify ihat I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of tt�e electricai work at: