P - 78950REQUEST FOR ELECTRICAL INSPECTION
�� 6.6 6�� Ci �� ��nnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
�(� �� (651) 642-08Q0 TTY/MRS 1-800-627-3529 www.etectriciry.state.mn.us
❑ NEW �EMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the work covered hy this request:
. �� �l-, r' �/a i.�<;Y'� (� 5/- �'% 7- �% i��S
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Apparatus (�a $.50
1
ONE 8� TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuit� and Two Inspection Trips Each Dweiling Unit @$80
Fee
Fee
fIFAMILY DWELLfNGS PER UNIT TOTAL FEE �
3 to 12 Units @$50 Per Unit (minimum total fee is $20)
E2Ch Addltlonel Unit @$25 Tws na�r, Foa nuvecTa+usE aar
I he2by certify that I inspected the electrical installation described herein on tlie dales sfa0ed:
OTHER ADDITIONAL FEES
Liahtina Rehofit � 5.25 oer Fixture � �� 5��
Hour
I Illl I! III II II! II lil II III II III II !II II III q� I illl
16661837
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Request Date: Roughan inspection Required? Y�
��� �nspection Other Than Rough-In: �Ready N YYII Ca��
Ya must call the inspectw when ready! Date Ready:
I certify that I am the �'LICENSED CONTRACTOR ❑COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
EB-000p1M14 BA.2002 � � �