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P - 77634REQUEST FOR ELECTRIC�L INS ��SI,ON ���-F'� - 9 4 4�3 Minnesota Board of Electrici y v�,�'^ av�+1 - 1821 University Avenue Suite S- 28, Sa rt�aul, Minnesota 55104 (651)642-OBOOTTY/MRS 1-800-627-3529 www.electriciry.state.mn.us ❑ NEW EMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the work covered by this request: ��4-I�C S�- _ �(f C� �o,.� _. �a�fl �%t,iro C SERVICES I AtARM, COMMUNICATION, REMOTE CONTROL, CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Each System Device or Apparatus @$.50 ADDITIONS TO THE GENERAL F MULTIFAMILY DWELLINGS PER UNIT 3 to 12 Units (a,l $50 Per Unit Exh Additional Unit (til $25 THIS n Boom $4( Park Lots S Paric Sites s tion $2 ! 530 cer Fbur Ilil IIIII IIIII II!!I IIIII Il1il IIIII Ilill �� I� 15419443 Outdoor Ligh6ng Standard @ $1 Traffic Sianal Standard � S5 ONE & TWO FAMILY DWELLINGS, EACH UNIT Includes the Service andlor Power Supply up to 500 Amperes, All Circuits and Two Inspection Trips Each Dwelling Unit @$80 Reins 6on Fee $20 L � TOTAL FEE rnnimum tofal fee is $20) iN15 MFA FOR INSPELTOft U$E Q"LY I hereby cer6ry that I inspec0ed the electrical installa6on deuribed herein on the da�s staled: � IF NOT -- s-G G Keque;t uate: Rough�n Inspection Required? ❑ Yes �No Inspedion Other Than RougMn: ❑Ready Now,s'CYill Call !/ ('�� 7� You must call the inspector when ready! Date Ready: I certify that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of tlie electrical work at: