P - 78673p REQUEST FOR ELECTRICAL tNSPECTION
1� 4 3����-F C� � Minnesota Board of Electricity - �:
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TlY/MRS 1-800-627-3529 www.electriciry.state.mn.us
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❑ NEW ❑ REM�DEL ❑ ADDITION ❑ REPAIR Describe -usinBihe baCk of the white c y if essary - the work covered by this reqyest:
GENERAL
>MMUNICATION, REMOTE CONTROL, SIG
CIRCUITS OF LESS THAN 50 VOLTS
iystem Device or Apparatus � $.50
ADDITIONS TO THE GENERAL FEES
3 to 12 Units �
Each Additional
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II��I II III IIIII.II �II II III IIIII II �I� IIIII �I� II� ... .
14316483
Outdoor
Standard 9
Fee $20
uo to 10 KVA
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$80
Fee
( TOTAL FE j I / JO ,��
minimum total fee is $20 ��(
THIS AREA FIXi INSPELTpi USE
I hereby certify that I inspec0ed the electrical inst�la6on described herein on tt� da0es sta�d:
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R �e+�� Rough-in Inspedion RequiredT ❑ Yes No tr�s aion p�her Than R
/�'S /� Pe ough-In: ady Nbw ❑ WiH Call
�.� v You must call the inspector wFien reedy� Date Ready:
I cefiy lhat I am the LICENSED CONTRACTOR ❑COMPANY ❑ OWNER and hereby request inspection of the electrica� w� a�:
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EB-0OOO1M14 8.1.2002