P - 780731-5�0-501 4❑
FEES
REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us
;EPAIR Describe -using Me back of the white copy if n the work covered by this
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Outdoor Liahtina Star�dard �1 S1
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
ADDITIONS TO �
MULTIFAMIIY DWELLINGS PEI
3 to 12 UniLs @ S50 Per Unit
OTHER ADDITIONAL
Retrofit � E.25 oer Fixlure
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes ihe Service andlor Power Supply up to 500 Amperes, All
Grcuits and Two Inspection Trips Exh Dwelling Unit @ E60
TOTALFEE I �7�
(minimum total fee is $20) Oct1.�
TH6 ARE� fIXi N15PECTdi USE MY
I hereby ceNy lhat I inspec0ed the electrical installation described herein on the dales stated:
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15305014 �� �d�
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Request Date: Rough-in Inspection Required4 ❑ Yes No Inspection Other Than Rough-In: �Ready Now Will Call
�� —2� � Vou must call the inspeclor when ready! Date Ready. � —��
I cerMy that I am the �ICENSED CONTRACTOR ❑CONIPANY ❑ OVIMER and hereby request inspection of the �ectrical work at:
Job Site Address (Street �X a Route No.) GtY ZD �
2(; So . �rn h-�r�i �e., �i2i �l � - �3�
Sectlon Tamship Range � Fire No. CouMy� 7
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Owner rR Name Please Provide Two (2) Phone Number(s) Induding Area Code
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IN87RtIC710N8 ON BACK
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EB-0OOO1M14 8.1.2002