P - 783871-4�9-9�1 �
❑ NEW ❑ REMODEL ❑
IE�RAL FEES
SERVICES I I
� 0 to 400
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Anoaratus �D $.50
Center
REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Sairrt Paul, Minnesota 55104
(651) 642-0800 TlY/MRS 1-800�27-3529 www•electriciry.state.mn.us
� Describe -using the back of the white copy'rf necessary - the work covered by this �equest:
i ^ �L�.s )YYV�t
f Outdaor Lighting Standard @ $1
Traffic Sianal Standard [�a $5 �
�ONE & TWO FAMILY DWELLINGS, EAGH UNIT
Includes ihe Service andlor Power Supply up to 500 Amperes, All
Circuits and Txro Inspection Trips Each Dwelling Unit �$80
_LINGS PER UNI TOTAL FEE � �
850 Per UnR (minimum total fee is $20) �'
Unit �$25 rHa r� Fan u��T«e usE aa�
I hereby cer6fy thart I inspected fhe electrical install�on described herein on the da�es sf�ed:
OTHER ADDITIONAL FEE _S �( G/ — � ° �� �' � �
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IIIII IIIII Iilll IIIII IIIII II III IIIII IIIII III� II� ,�#�� �
14999817 �,�-v
Request Date: Rough�n Inspedion Required't � Yes Irupedion Other Than RougMn: ❑Ready Nav LJ VVpI Call I
�! �/�� You must call the inspector when ready! Date Ready: i�' /� �Q �
6f-�
I cerGfy that I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of Cie elecfical woAc at: