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P - 78594REQUEST FOR ELECTRICAL INSPECTION 1����.— g 2 2� Minnesota Board of Electricity - 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 (/�.��� (651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us ❑ NEW EMODEL DD yTION ❑ R PAIR Describe -using the back of tt�e white copy if necessary - the work covered by this request: �r�b �ausv►, 6s!_� �?.—� GENERAL FEES Outdoor Li htin Standard $1 SERVICES I POWER SUPPLIES . TraRc Si nal Standard E5 ALARM, COMMUNICATION, REMOTE CONTROL, CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS 3 to 12 Units Each Additio Boom ( II� II III II IiI 1I III II III II III II III II III ��I I�ii 1 3 9 9 9 2 2 2 to ONE & TWO FAMILY DWELLIN�S, tn�n Urvi i Includes ihe Service andlw Power Supply up to 500 Amperes, All Circuits and Two Inspec6on Trips Each Dwelling Unit �$80 Additional Inspecdon Trips $20 Investiaative Fee TOTAL FEE � !J (minimum total fee is $20) � ���� iH6 NiFA fpi 1ISPECTIXt USE 011Y I hereby cerAfy th� I inspec�d the � insMatlaOai destxibed haein on tlie daks sf�ed: ti�� r4. rg =k.'±'�. t .cs� C7A!'-.�$ �7�6 a .�� Request Date: Rough-in Inspedion Required? ❑ Yes No Inspection Other Than Rough-In: �Ready Now I Cell ��g� V� You must cal� the i�spector when ready! Dale Ready: I certify tliat I am 1h��'CICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at: Job Site Address Street BoX a Roule No.) �Y ��8 ��s�� h�� c�►-� �rE �;�� ss�.� �r��v Ham Cake, MN 55.904 c� License Number ONBACKOFYELLOWC . BOARD ELECTRICfTYCOPV EB-0OOO1Mt4 8.1.2002