P - 79247REQUEST FOR ELECTRICAL INSPECTION
��� 1 O- 6 4 2� Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TlY/MRS 1-800-627-3529 www.electriciry.state.mn.us
NEW ❑ REMODEL ❑ ADDfTION _ 0 REPAIR Describe -usingthe back o,f„Sh,e white copy if necessary - the work covered by this request:
✓iCES I POWER SUPPLIES
0 to 400 Amcere Cd $25
ALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL
@ $25
Outdoor Liah6na Standard
ONE 8 TWO FAMILY DWELLINGS, EAGH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$80
TOTAL FEE �O.�JO
(minimum total fee is $20)
THISMEAFOR CTIX1l15Ep1Y
I hereby cer6fy mat 1 inspected the ek�ctrical install�on described herein on the da�s stabd:
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Request Date: Rough-in Inspection Required? ❑ Yes Inspec6on Other Than RougMln: ❑ dy Now ❑ Will Call
�7��� You must cali the inspectw when ready! Date Ready:
I certify that I am the �ICENSED CONTRACTOR �COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
INS7RUG710N8 ON BACK OF YELLOW COPY BOARD OF ELECTRICRV COPY EB•00001M1d 8.1. 20U2