P - 78961REQUEST FOR ELECTRICAL IfVSPECTION
1���� � g�� � Minnesota Board of Electricity -
1821 U�iversity Avenue Suite S-128, Saint Paul, Minnesota 55104
. (651) 642-0800 TTY/MRS 1-800�27-3529 www.electriciry.state.mn.us
❑ NEW Q REMODEL ADDITION ❑ REPAIR Describe -using the back of the white oopy if necessary - the work covered by this request:
I-30 ,�m P Ct , Caanv ) t�.4.�e� I c� � �-�
GENERAL FEES Outdoor Liqhting Standard na. $1
Q to 4�0
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
3 to 12 Units ta� S50 Per Unit
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Uwelling Unit @$80
�vi�rc�
(minimum total fee is $20) �(% ,
TMS AREA WR 1ISPECiOR USE ONLV
I hereby c that � inspec0ed the elettrical installa6on described herein on the dates sfafed:
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R uest Dat •` O� Ro�gh� Inspedion Required? Yes ❑ No I�pection OIF�ar Than ROUgh-In: OReady Now WiN Call
You must call the inspector when ready! ps►e �y.
I certiiy that I am the �LICENSED CONTRACTOR �YPr►NY ❑ OWNER and hereby request inspection of the electrical work at: