P - 78931REQUEST FOR ELECTRICAL INSPECTION
1— 6 Q, 7�� 8 4 � Minnesota Board of Electriciry -
�/ 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
�k � (651) 642-0800 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us
❑ NEW REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy 'rf necessary - the work covered by this request:
C�ab �' t �w - -►- $S
GENERAL FEES Outdoor Li htin Standard $1
SERVICES / POWER SUPPLIES Traffic Si nal Standard $5
0 to 400 Amcere � 825 Suuolemental Fee (a� $20
0 to 200 Am e$5
Above 200 Am e $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
Lighting Retrofit � $.25 per Fixture
Center Pivot Irtigation Boom @ $4(
Manufactured Home Park Lots @ i
Recxe�onal Vehide Park Sites �
lilll NIII IIIII II Iil IIIiI illli lllll Ilili a� i�
16476848
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes ihe Service andlor Power Supply up to 500 Amperes, All
GrcuiLs and Two Inspection Trips Each Dwelling Unit �$80
Addifional Insoection Trias � $20
(minimum total fee is $20) � pC-V"�r�
T WSAREA FOR RiSPECTpt USE OKY
I hereby cer6y tl�at I inspec�d the elec6ical i�tatla6on desaibed herein on tlie d�es staled:
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R�� �� Rough-in Inspecfion Required? ❑ Yes Inspection Other Than Raugh-In: ❑Ready Now I Call
����O You must call the inspector when readyl Date Ready:
I certify that I am tt�e L�"ICENSED CONTRACTOR ❑COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
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License Number
EB-0OOO1Mt4 &1.2002