P - 78186REQUEST FOR ELECTRICAL INSPECTION
1� 5 9 0-19 7� Minnesota Board of Electricity
��ya � 1821 University Avenue Suite S-128, SaiM Paul, Minnesota 55104
. (651) 642-0800 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us
O NEW REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back qf ttie white copy 'rf necess�- the work covered by this request:
GENERALFEES
401 to 800
Above 8W
GRCUITS / FEE
0 to 200 N
ALARM, COMMUNICATION, REMOTE CANTROL, SIGNALING
GRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Eaoh S tem Device or atus S•50
ADDITIONS TO THE GENERAL FEES
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15901978
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wr Li9htina Standard
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes ihe Service �dlw Pawer Supply up to 500 Amperes, All
Grcuits and Two Inspection Trips Each Dwelling Unit @ f80
Reins tion Fee $2(1
TOTAL FEE
(minimum tohal fee is $20) c�� � �
THSME�FdiRbPECTdiU5E011Y
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IF NOT COMPLETED WITHIN 12 MONTHS
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Request Date: /; Rough�n Inspection Required? ❑ Yes Np Inspedion Other Than RougFNn: ❑Ready I Call
�— j�� V� You must call lhe inspeda when ready! Date Ready: .
I certi(y ttiat I am 1he ICENSED CONTRACTOR ❑ COIu�ANY ❑ OWNER and heieby request inspeciion of the electricxl work at: