P - 79145REQUEST FOR ELECTRICAL INSPECTION
1•• 7� e�`�z•: 4 6 4� Minnesota Board Qf Electricity -
� 1821 University Avenue Suite S-128, Saint Pa�l, Minnesota 55104
(651)642-0800TTYlMRS1-800�27-3529 www.electricitystate.mn.us
C�',NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
SUPPLIES I I Traffic
Fee
0D f0
0 to 200 Am re $5 ONE & TWO FAMILY DWELLINGS, EACH UNII
Above 200 Am ere $10 Includes the Service and/or Power Supply up to 500 Amperes, All
ALARM, COMMUNICAT�ON, REMOTE CONTROL, SIGNALING CircuiGs and Two Inspection Trips Each Dwelling Unit @$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Inspection_Trips� $20
iIFAMILY DWELLINGS PER UNIT TOTAL FEE I �6.
3 to 12 Units @$50 Per Unit (minimum total fee is $20)
E�h Addition2l Unit Q$25 rwsnaenFaeua�crrnusEaar
I hereby certify that I inspected tlie electrical insfalta6on described herein on Me da[es sWed:
OTHER ADDITIONAL FEES �QjG � ��, a 3�S
U htin Retrafit $.25 r Fixture
Center Pivot irtiaation Boom f� S40 Ra'�"'" �,rE
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R t Date: Roughin InspeCtion Required? � Yes ❑ No Inspection Other Than Rough-In: OReady Nav+ C�Ylfill Cafl
12�-8-04 You must call the inspector when ready! Date Ready:
I certify that I am tt�e �J UCENSED CONTRACTOR OCOMPANY ❑ OWNER and her�by request inspection of the electrical work at: