P - 77224- ---
REQUEST FOR ELECTRICAL INSPECTION �
1 _ � /� � � � � 7 � Minnesota Board of Electricity -
`f � 1821 University Avenue Suite S-128, Pa Minnesota 55104
(651)642-0800TTY/MRS 1-800� - .electricity.state.mn.us ""
❑ NEW ❑ REMODEL 0 ADDITION ❑ REPAIR -�si the of it�v�e essary - the work covered by this request:
�J� C
GENERAL FEES Outdoor Li h6n Standard $1
SERVICES / POWER SUPPLIES Traffic Si nal Standard $5
0 to 400 Amcere O 825 Supo�emental Fee p$20
Above 200 Am ere $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A ratus $.50
ADDITIONS TO THE GENERAL FEES
Addi6onal Unit
FEES
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two InspecUon Trips Each Dwelling Unit @$80
Additional Ins tion Tri $20
Investi ative Fee
Reins tion Fee $20
AL FEE
(minimum to fee is $20) � `
MIS/JiEAFORINSPECi ONIV
I hereby certify Mat I inspecfed el�e6ical i n described herein on the dates sta�ed:
� THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS �
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Requ t a e� Rough-in Inspection Required? ❑ Yes No Inspedion Other Than Rough-In: y Now 0 Will Call
You must call the inspecla when ready! Date Ready:
I certify t I am th CENSED CONTRACTOR ❑ COMPANY ❑ OWNER and he2by request inspection of the elec,�trical work at::
Job Sit� � (Strpqt, 6°� f,E�(J�j„ ,� City ��� Zip C e�.�
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��A: �OLDEN VALLEY HEATINQ & AI
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Master ElecVician or P
License Number
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INSTRUCTONS ON BAGK OF VELLOYV COPY BO OF ELECTRICITV CO V EB-00001A-14 8.1. 2b02