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P - 78185r REQUEST FOR ELECTRICAL INSPECTION \1 �� v"�`� � O � g121 Un'��versity A en� e 3uite S- 28, ul, Minnesota 55104 (651) 642-0800 TTY/MRS 1-800 www.electricity.state.mn.us /' -• " — ❑ NEW ❑ REM ❑ ADDIT N❑ REPAIR Describe -yAng the k ofjthe wh e copy if n essary - the work covered by this request: FEES SERVICES / POWER SUPPLIES CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Each System Device or Apparatus @$.50 ADDITIONS TO THE GENERAL MULTIFAMILY DWELLINGS PER UNIT 3 to 12 Units @$50 Per Unit Each Additional Unit @ $25 OTNER ADDITIONAL FEE£ �gh6ng Rehofit @ $.25 per Fixture Center Pivot Irtiaation Boom (a� $40 IIII II� IIIII IIIII III�I II��I I�I�I IIIII �� I�I 15864200 ONE & TWO FAMILY DWELLINGS, EACH UNIT Includes the Service and/or Power Supply up to 500 Amperes, All Circuits and Two Inspec6on Trips Each Dwelling Unit @$80 TOTAL FEE I (minimum total fee is $20) �/� � iHIS ARFA FOR I�bPECTqi USE OIIY I hereby certiry fhal I inspected the elecbical insUlla6on described herein on the dates stated: �- z %- �" `'� i�-� j3s7 Cfz:�-a ��o � av s� ��o�� �U Request Date: Rough-in Inspection Required? ❑ Yes ❑ No Inspection Other Than Rough-In: Ready Now ❑ Wrll Call � D You must call tne inspeclor when ready! Date Ready: I certi(y that I am the �LICENSED CONTRACTOR ❑ COMPANY C OWNER and hereby request inspection of ihe electrical work at: /� Job Site Address (Street, Box, or �ioute No.) / _ i CiN , e Zio Code , CTRt�3' tNC. `�! r � nse Number Master Eleclrician or P .-. . � i License Number./) � - ���" �S%'.��� INSTRUGTONS CK OF BOARD OF ELECTRICITY COP� EB-Op0p1A-14 8.1. 2002