P - 781981:-�90-154 9❑
Ck. 535ej
0 NEW REMODEL ❑ ADDITION ❑
C L�•l
GENERALFEES
SERVICES / POWER SUPPLIES
0 to 400 Amcere � $25
REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us
� Describe -using the back M ihe white copy 'rf necessary - the work covered by this request
� - �18�'s
Outdoor Li htin Standard $1
TraRc S' nal Standard SS
Suoolemental Fee � 820
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or aratus $.50
ADDITIONS TO THE GENERAt FEES
2 Units @ $50 Per Unit
Additional Unit @ b25
n BOOrtI �
Park Lots S
Park Sites
> tion 82
! E30 Der Fbur
I iIN II �I il IN II II{ il III II II� II ill II III �� I�
1590154g.
a s ( S-v`f
I certify that I am the �
tiox, or
�e.k
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes ihe Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @ S80
TOTAL FEE �O
(minimum total fee is $20) ��•�
THIS AREA Fpl MSPECTpi USE 011r
I hereby cerdy fhal I inspected the ekctricai insfallation described herein on ttie dates stated:
- � i -_<-- f� —
�IIPLETED WITHIN 12 MONTHS`
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�,� s-3s�
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Roughin Inspection Required? ❑ Yes�No `Inspediai Other Tha� Rough-In: ❑Ready No� Will Call
You must call the inspector when ready! I Date Ready:
NSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request �spection of tlie electrical work at::
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BOARD ELECTRICITVCOPY EB-00001M14