P - 78598/�r� REQUEST FOR ELECTRICAL INSPECTION
1 '# O L- 3 81 � Minnesota Board of Electricity
., 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
� (651) 642-0800 m/MRS 1-800-627-3529 www.electriciry.state.mn.u.s
❑ NEW ❑ REMODEL 0 ADDITION ❑ REPAIR Describe -using the back M th whit copy if necessary - the work vered b thi
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GENERAL FEES Outdoor Lighfing Standard �$1
0 to 400 At
401 to 800
Above 800
ALARM, COMMUNICATION, REMOTE GONTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
3 to 12 Units �$50 Per UnR
Exh Additional Unit � $25
FEES
Center
ONE & TWO FAMILY DWELLINGS, EAGH UNIT
Indudes ihe Service andlor Power Supply up M 500 Amperes, All
Circuits and Two Inspection Trips Exh Dwelling Unit �$80
(minimum total fee is SZO) �,�j' (�'C_/
TMSMEAFORINSPECT 0lLY
I hereby ce�tify Mat I i�pecbd the elecAical ir�tall�on desuibed herein on the daffis sf�ed:
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Req Date' l� Rough-in Inspection Re9uired4 ❑ Yes Inspedion Other Than R�wgMn: y Now ❑ WMI CaR
� U Vou must call the inspecla when readyl �te Ready. .
I certify I am the LICENSED CONTRACTOR ❑ CONIPANY ❑ OWNER and her�y ►equest inspec.'tion of 1he elec6ica� wwlc at:
Jab ' Address� Box. Oe No:) ,/ / v� %� ' , �� ��/ --°' ' �
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Seciion Township �� �re No. CouMy
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& so�v.s E�.ECTRic c �
n��el�� s Ilafion)
., MN 55429 ✓%
OI Lioense 1�mber
x�strtuenoHS on swut oF reuow eorr / eoiwn oF ei�eTwem coPV es�ooao��-u e.�. 2ao¢