P - 78826REQUEST FOR ELECTRICAL INSPECTION
1� 6 0- 2 4 7�8 Minnesota Board of Elecficity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
�� �� � � (651)642-0800TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us
❑ NEW REMODEL 0 ADDITION ,� REPAIR Describe -using the back of the white copy 'rf necessary - the work covered by this request:
GENERALFEES
SERVICES / POWER SUPPLIES
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
TO THE GENERAL FEES
3 to 12 Units �$50 Per Unit
Each Addition� Unit � $25
I Special Inspection �$.31 per Mile
^ THIS INSTALLATION MAY BE ORDER
I IIII (I III II (I� II III II �II II II� I� (II II III �� I�
14602478
Standard
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes U�e Service andlor Power Supply up to 500 Amperes, All
Grcuits and Two Inspection Trips Each Dwelling Unit � EBO
Reins tion Fee $20
TOTAL FEE � �j
(minimum total fee is $20) p� ��
TM6 �RFA Fdi M15PELTq2 USE dlY
I hereby ceNry Ihat I inspected the ekctrical installation descrihed herein on tl�e dates stahed:
� ��
NOT COMPLETED WITHIN
�'�°6 3 �o.So
Request Dafe: Rough-in Inspection Required? ❑ Yes o Inspedion Other Than Rough-In: ❑Ready Now I Call
�'03 You must call the inspector when ready! Date Ready.
I certify that 1 am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
H187RUC710N8 ON BACK OF YELLOW COPY BOARD OF ELECTRICIT' CAPY E&00001M14 8.1. 2002