P - 791171-700-527�
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O NEW' REMODEL ❑ ADDITION ❑
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GENERALFEES
�ALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
� Each Svstem Device or ApDaratus �$.50
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
Fxture
Hour
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L7005273 -
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
R Describe -usin t�back of the white copy 'rf necessary -��rk coverg�by this request:
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Outdoor Liahtina Standard an $1
Transformer / Power Su I for Si ns I OuUine Li h6n 55
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additional Ins tion Tri s $20
Invesfi ative Fee
Reins tion Fee $20
TOTAL FEE .t�
(minimum total fee is $20)
TNIS AREA FIX21�1SPECTOfi 115E ONLV
I her y certify th inspected the elecbical installatian described herein on the dates siahed:
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I��u t Date: Rough-in Inspection Required? Q Yes No hsped'wn Other Than Rough-In: �Ready Now V1NII Call
�a� `� You must call the inspector when ready! Date Ready. ,
I certify that I am the �ICENSED CONTRACTOR ❑CONIPANY ❑ OWNER and hereby request inspection of tlie electrical work at:
,lob Site Address (St2et Box, or Route No.) city Zip Code
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3562 Centrai
OF ELECTRICT' COPY
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wasu.v t�ecmcian a
License Number
E&OOOOtA•74 8.1.2002