P - 78239/� REQUEST FOR ELECTRICAL INSPECTION
1—�t 4. 5— 6 3 9 � Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800�27-3529 www.electriciry.state.mn.us
❑ NEW DEL 0"ADDITION . EPAIR Describe -using the back of ihe white copy 'rf necessary - ihe work covered by this request:
.4-t�� "E— �
GENERAL FEES Outdoor Li htin Standard $i
SERVICES I POWER SUPPLIES _.. �LI Trafic Sianal Standard � 85
to 800
U 100 re g5 ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
A Am re $10 Includes the Service and/or Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspeclion Trips Each Dwelling Unit @$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins tion Tri $20
Each Svstem Device or Aouaratus �$.50 Investiaative Fee
IITIONS TO THE GENERAL FEES Reins 6on Fee $20
.LIN6S PER UNI TOTAL FEE �
$50 Per Unit (minimum total fee is $20) J'
Unil @$25 *�ns n�n Fat irsaecrca use aar
I hereby cert(y that 1 inspected the ek�ctrical installa6on described herein on the dafes smted:
OTHER ADDITI ONAL FEES /
$.25 er Fixture �� // � •!/�
afion Boom $40 RO'�"'" o�re
ame Park Lots $25 t�0' �"
hICIE Per1C SIfCS $5 F'� �CT10N DATE
i Ins Uon $20 � � �� �
M�$� D@f HOUf E�oi�eNmEO � oaTE
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14456396 '(���
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ReQue� Dat : Rough-in Inspection Required? ❑ Yes ❑ No Irspection Other Than Rough-In: ❑Ready Now ❑ Wili Call
G`� You must call the inspector when ready! Date Ready. .
I certity ihat I am the ❑ LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby iequest inspection of ihe electrical work at•:
Job/ /I\ '' � a- te �b.) / Cib ' Zip Code
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i Vl � 7
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Master t�ecmuan or
License Number
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18 ON BACK OF VELLOW COPY BOARD OF ELECTRICITV COPV EB-00001M74 8.1. 2002