P - 76403n n REQUEST FOR ELECTRICAL INSPECTION �
�� 7� O� O 4J o j,L l Minnesota Board of ElecVicity
U 1821 Universify Avenue Suite S-128, Saint Paul, Minnesota 55104
(651)642-OBOOIIY/MRS 1-800-627-3529 www.electricity.state.mn.us
❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of ihe white copy 'rf necessary - the work covered by this request:
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GENERAL FEES Outdoor Li htin Standard $1
SERVICES ! POWER SUPPLIES Traffic Sianal Standard O SS -
)MMUNICATION, REMOTE CONTROL,
CIRCUITS OF LESS THAN 50 VOLTS
�vstem Device or Anoaratus � $.50
3 to 12 Units @$50 Per
Each Additional Unit Co� ;
OTHER
Ligh6ng Rehofit � $.25 p
Center Pivot Irriaafion Ba
� Transformer I Power Supply for Signs I OuUine Liqhfing $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes ihe Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$BO
Fee
Fee
(minimum total fee is $20) � 7p(�J���
TIHS N2EA FOR INSPECTOR USE Oiv
1 hereby cer6fy that � inspected the electrical installaEon described herein on the dates stated:
5 121 IfIS �Ofl $� f H011f ExRaEOi�r�no�o ��—
S ial Ins 6on $.31 r Mile
�HIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHI
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nequesc uate: Rough-in Inspection Required? ❑ Yes �No Inspedion Other Than RougMln: ,�2eady Now 0 Will Call
/� �i0 7 You must call the inspector when ready! Date Ready:
I certify that 1 am the i�ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job ' Address (Street, Bo or Route No. Ciry Zip Cade
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License Number
SprinY�r �iectri�al Services GA03969 A�!;00�37E
2�2F lVPvada Ave �J #203, Golden Valley PYi,� �5�'"
Phone 763-546-80r�'� Fax 763-54S-S084
BOARD OF ELECTRICITV COPV EB-00001A-14 8.7. 2002