P - 79100c REQUEST FOR ELECTRICAL INSPECTION
�� 6 5 4� V�°'�' � Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paui, Minnesota 55104
' (651 } 642-0800 TlY/MRS 1-800-627-3529 www.electricity.state.mn.us
❑ NEW ❑ REMODEL 0 ADDIT�ON ❑ REPAIR Describe -us�ng�h�b�cl�f the white� if ae�essa�-xie � ncovereiby this request:
to 800
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A aratus $•50
ADDITIONS TO THE GENERAL'
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units @$50 Per Unit
Each Addi6onal Unit @ $25
NSTALLATION MAY BE ORDERED I
ONE 8 TWO FAMIIY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspeclion Trips Each Dwelling Unit @$80
TOTALFEE
(minimu dtal fee is $20)
rr�s aaFn FoR insrECica �
1 hereby certiy Mat l inspe te Me electrical installation
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nerein on the dates stah.M:
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— i certify �tat I
Rough-in Inspection Required? Yes No Inspedion Other Than Rough-In: Raady Now [7 Will Call
You must call the inspecta wlien readyf Dale Ready:
NSED CONTRACTOR ❑ CONIPANY ❑ OWNER and heieby request inspection of the electrical work at:
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EB-0OOD1M4 B.t.2002