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P - 79237` REQUEST FOR ELECTRICAL INSPECTION � �� Z G Q��� O� Minnesota Board of Electriciry C7 V O 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 � (657) 642-0800 TTY/MRS 1-500-627-3529 www.electriciry.state.mn.us NEW ❑ REMODEL ❑ ADDITIQN � O REPAI� Descnbg=qs,,�ng,th,g b�k o�el, w, hite copy iF necessary - the wak covered by this request: 0 to 400 Ai 401 to 800 tM, COMMUNICATION, REMOTE CONTROL, SIGNALING UITS, CIRCUfTS OF LESS THAN 50 VOLTS Each System Device or Apparatus @$.50 ADDITIONS TO THE GENER,4L FEES fIFAMILY DWELLINGS PER UNIT 3 to 12 Units @$50 Per Unit Each Additional Unit @ $25 Siandard ONE & TWO FAMILY DWELLINGS, EACH UNIT Includes the Service and/or Power Suppty up to 500 Amperes, All Circuits and Two InspecGon Trips Each Dwelling Unit @$80 TOTAL FEE ?p.�O (minimum total fee is $20} r�ns arsen rae miscecrae usF aar I hereby certify ffiat I inspected !he electrical installation described herein on the dates staled: � 6Q� �d�T �� I IIN ll lll � lll ll �l ll lll ll�l li lli ll lli � lll ! Ilil R ��9� L 7 6 8 5 6 8 6 Q�,�/' �� ��� � � " �6 - S�CS Hequest oa[e: Roughin InspeCtion Required? LJ Yes LJ No Inspection Other Than Rough-In: UReady Now U Y�lA1 Call 07��� You must ca0 the inspector when ready! Date Reedy. I certity that I am the �ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the elecficai work at:: INBTRUCTONS ON BAGK OF VELLOW COW BOARD OF ELECTRICT' COPV EB-0OOO1M11 8.1.2002