P - 79084REQUEST FOR ELECTRICAL INSPECTION
1� ,,�, — 4 4, o� Minnesota Board of Electricity
� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
� S� (651) 642-0800 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us
❑ NEW REMODEL ❑ DDITION ❑ REPAIR Describe -using the ack of th white copy if necessary - the work covered by this request:
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GENERAL FEES Outdoor Liqhting Standard (�a. $1
SERVICES I POWER SUPPLIES
ALARM, COMMUNICATION, REMOTE CONTROL, SI�NALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or ralus $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
Center Pivot Irriga6on Boom �
Manufa�tured Home Park Lots
Transformers
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
IncYudes the Service andlor Power Supply up io 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
(minimum total fee is $20) � �(J �
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I hereby cerdfy Mat I inspected the ek�ctrical installaUon described herein on tl�e dMes staBed:
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THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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ReQuest Date: Roughln Inspection Required? ❑ Yes o Inspediai Other Than RougMn: OReady Now Wdl Ca�l
s"! �` 6 y You must call the inspector whq� ready! Date Ready.
I certify that I am the�ICENSED CONTRACTOR ❑COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Sile Address (Sfreet, Box, or Route No.) City Zip Code
510 ��leri Lc� N� �r� ��-es.� SS�F�, I
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IN87RUGTION80NBACKOFYELLOWZbR9 BOAR/OFELECTRICITYCOPV EB•00001M14 8.1.2002
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