P - 78705/� /� REQUEST FOR ELECTRICAL INSPECTION
1'� �F ��F -15 5� Minnesota Board of Electricity
1821 University e Suite S-128, Saint Paul, Minnesota 55104
(651)642-080 S 1-800-627-3529 www.electriciry.state.mn.us
❑ NEW ❑ REMODEL ❑ ADDITION REPAI Describe -usi,n,s ack of the white co�r if necessary - the work covered by this request:
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SERVICES I
r��u�na Transiortner / Power Su for Si ns I OuUine Li htin $5
10 Am re $5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
2(10 Am re $10 Includes ihe Service andlor Power Supply up to 500 Amperes, All
)MMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit �$80
CIRCUITS OF LESS THAN 50 VOLTS Additional Ins tion Tri $20
� stem Device or ratus $.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reinspection Fce �$20
3 to 12 Units �$50 Per Unit (minimum total fee is $20) - S(�
EachAdditionalUnit�$25 _. ��+�s�,FOn cTanuseaar
I hereby cer6ry that I inspected Me ekctrical insfall�on desciibed herein on Me dabs st�ed:
OTHER ADDITIONAL FEES ��� �.y,,�„�
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Req e: Rough-in Inspedion Required? ❑ Yes ❑ No Inspection Other Than Rough-In: eady Now ❑ Will Call
Yai must call the inspector when ready! Dale Reedy:
I certify tt�at I am tl�e LICENSED CONTRACTOR ❑ COMPANY � OWNER and hereby request inspection of the electrical work at:
J� Site Address (�reet, Bwc, a Route N. City Zp Code
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INSTRUCTIONB ON K OF VELLOW C BOARD OF ELECTRICITY CAPV EB-00001M14 8.1. T002