P - 79141REQUEST FOR ELECTRICAL INSPECTION
1��� J- 4 5 9❑0 Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
' (651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
�J NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
✓ICES / POWER SUPPLIES
0 to 400 Amcere (� $25
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL F
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
Pivot Imaation Boom
Su demental Fee $20
Transformers u to 10 KVA $10
Transformers over 10 KVA $ 20
Transformer / Power Su I for Si ns I Outline Li htin $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspec6on Trips Each Dwelling Unit @$80
Additional Inscection Trios Cd $20
Reins tion Fee $20
TOTAL FEE 46. 'rJ�
(minimum total fee is $20)
rws naEn F«i uxaEC.oa use «a.
I hereby certify that I inspected ttie electrical insUlla6on described herein on Me dates sta0ed:
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R6599 ��e`
�� �8� 04 Rough-in Inspection Required? y� �� ��
You must call the inspecyor when ready! Da� �ah� Than RougMn: �Ready ►�bw Will �II
I certify that I am the � UCENSED CONTRACTOR ❑ COMPANY ❑ OWNER arM hereb
�o� ��d� (s��, _ewc or �,�P N„ , _ Y�4uest inspection of the electrical work ai:
Management Corp
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----•..'. J.•• CA0111 p--� u�� w bern or F'ower Limited Te�hniciai
Mailing Address (Contraclor. ComPenY or Owner Perlarming InsfaAation)
8164 ur Street NE, Spring Lake Park, NIl�T 55432
�Of�� (Contrador, Com a Owner Rerfortning Instellabon)
���� 784-3729
INBTRU 8 ON BpCK OF Cpp�.
BOARD OF ELECTRICITV CppY
. E&OOOp1M1t 8.1.2002