P - 78435REQUEST FOR ELECTRICAL INSPEG�tION
1�(i, 5�— 7 1'�'J � Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 T1Y/MRS 1-800�27-3529 www.e[ectricity.�State.mn.us
❑ NEW ❑ REMODEL ❑ ADDITION REPAIR Describe -using the back of the white copy if necessary - the work Qovered by this request:
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GENERAL FEES Outdoor Li htin Standard $1
SERVICES I POWER SUPPLIES Traffic Si nal Standard $5
0 to 400 Am re $25 e. cio Su lement� Fee $20
401 to 800 Am re $50 Transfortners u to 10 KVA $10
Above 800 Amcere Cal $75 Transformers over 10 KVA � S 20
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aouaratus �$.50
Additional Unit
I�� �III II„� �I�II II�� II�II �III II� ��.I�
14507156
Kequesi u�e: Rough-in Irtspection Required? ❑ Ye
"� �� " � 3 You must call the inspectar when ready!
I certify that i am the ICENSED CONTRACTOR ❑ COMPAI
J� Sile Address (Street 8ox, or Route No.)
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ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes ihe Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$80
TOTAL FEE Qr ��
(minimum total fee is $20) �
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I hereby certify thffi I inspected the elechical insf�lation described herein on tl�e dales shated:
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Inspedion Other Than Raugh-In: Ready Now � WNI Calt
Date Ready. � 3 �
� OWNER and hereby request inspection of the electrical work at:
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PI Provide Two (2) Phone PNimber(s;
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License Number
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EB•00001A44 8.1.2002