P - 78434REQUEST FOR ELECTRICAL INSPECTION
�, � 4 9 4� ��� � Minnesota Board of Electricily -
1821 University Suite S-128, SaiM Paul, Minnesota 55104
(651)642-080 1-800-627-3529 www.electricitystate.mn.us
❑ NEW ❑ REMODEL ❑ ADDITI ❑ RE IR Describe -using ack of the white� opy if necessary - the work covered by this request:
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I SERVICES I POWER SUPPLIES
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
MULTIFAMILY DWELLINGS PEI
3 to 12 Units �$50 Per Unit
Each Additional Unit @ $25
Cenier Pivot Irriaation Boom
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ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuils and Two InspecGon Trips Each Dwelling Unit @ S80
Additional Inspection Trips . $20
Investiaative Fee
(minimum total fee is $20) � �v 'J �
T IILS AREA FIX1 INSPECTOR USE OKY
I hereby certify that I inspected tl�e electrical installa4on described herein on Ihe daBes stafed:
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Request Dete: Rough-in Inspection Required7 ❑ Yes ❑ No Inspection Other Than Rough-In: Ready Now ❑ Wdl Call
� �(,/� You must call the inspeGOr when ready! Date Ready:
I certify that I am the �'cICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspecfion of the elect►ical work at:
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EB-00001M14 8.1.2002