P - 79142REQUEST FOR ELECTRICAL INSPECTION
�� 7 2 5-� 61 �6 Minnesota Board of Electricity -
1821 University Avenue Suite S-12$, Saint Paul, Minnesota 55104
, (851) 642-0800 TTYIMRS 1-800-627-3529 www.electriciry.state.mn.us
I�NF+N ❑ REMODEL ❑ ADDITION ❑ REPAIR Describe -using ifie back of ihe white copy'rf necessary - the work covered by this request:
0
to 600
Outdoor Liqh6nq Standard
0 to 2U0 Am re 55 ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re $10 Includes the Service and(or Pawer Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING CircuiLs and Two Inspection Trips Each Dwelling Unit �$60
CIRCUITS, CIRCUITS OF LESS THAN 5D VOLTS Additional Ins tion Tri $20
Each SYStem Device or Apparatus �$.50 Investiaative Fee
111'AMILT UYYCLLIIVb� rtrcuni� IulALttt 46. r.J
3 ro 12 Units @$50 Per Unit (minimum total fee is $20)
E2Ch Addlti0nal Unit �$25 rH�s u�n Fors xs�c*oa usE orar
I hereby cer6y tl�at I inspecled the electrical installa6on desxibed herein on the dafes sf�ed:
OTHER ADDITIONAL FEES
Lighting Retrofit �$25 per Fi�Aure �c Y' �1 �' ✓� G�
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Rw� �: Rough-in Inspection Required? � Yes ❑ No Inspedion Olher Than Rough-In: ❑Ready Now CxWlll Call
12-8-04 You must call the i�spector wSren readyl �� �r .
I certity ihat 1 am tl�e gl LICENSED CONTRACTOR O COMPANY O OWNER and hereby request inspeclion of the electrical work at: