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P - 78034` REQUEST FOR ELECTRICAL INSPECTION ,1- 5 4 8- 7 41 � Minnesota Board of Electriaty 1821 University Avenue Suite - , Saint Paul, Minnesota 55104 �� (651) 642-0800 TlY S -8 -3529 www.electricity.state.mn.us � O NEW REMODEL ADDITION O REPAIR �4a-usi of e white cop if necessary - the xrork covered by this request: SERVICES / POWER 0 to 400 Amcere )MMUNICATION, REMOTE CONTROL, SIGNALING CIRCUITS OF LESS THAN 50 VOLTS 3 to 12 Units @ S50 Per Unit Each Additional Unit � i25 OTHER ADDITIO! Lighting Retrofit � E•25 per Fiature Center Pivot Irrig�ion Boom @ E4( M�ufaclured Home Park Lots � i Recre�onal Vehide Park Sites @ Separate Bonding Inspection @ S2 Soeci� Insoection � E30 cer Fbur Outdoor Fee � Tr�sfomier / Power SuDP�Y for Signs I Outline Lighting @ s5 ONE & TWO FAMILY DWELLINGS, EACH UNIT Indudes ihe Senice andlor Power SuPpIY up to 500 Amperes, All Grcuits and Two Inspection Trips Each Dwelling Unit @ E80 ivin�ree (minimum total fee is $20) TlWS MFA FOR MSPECiOR USE plY I hereby cerOfy tlial l inspeckd the dx4ical instaYaEon desaibed haein on the d�s sta0ed: :^-�` �' Z � �� y�a 1 �,lr� I�Ilillllllilllllllllllllll�ilillllllil��l� � .,.� � 15487416 � � aos uest Dete: Roughin Inspecfion Required? ❑ Yes ❑ No I�spectiai Other Then RougMn: y Now ❑ VNII Call /� C� You must call the inspedor when ready! Date Ready. . I cerMy Uiat i am 1he �IICENSED CONTRACTOR ❑ CO�ANY ❑ OWNER and hereby request inspection of 1he electrical work at: / I c� / J� � ,"°°,'i� � „ e°�.'°�.�"°� . _ , i _ 3 � / � �°°e ./ � � � a� � � wsmucnows ��C�� : Please Provide Two (2) Phone Number(s) Indu ('� L��y�; � ) �� a�� v�� ►�� „ . ,�- � eo�ao oF �c�wcm corr 7..�7� s�� EB-0OOO1M11 8.1.2002