P - 79200REQUEST FOR ELECTRICAL INSPECTION
. � �' ! � � - 5 2 �J� Minnesota Board of Electricity - _
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
{651) 642-0800 TTYIMRS 1-500-627-3529 www.electriciry.state.mn.us
a REMODEL ❑ ADDIT�eEL ENE�RGY c�-����b�ck_ _of t,Lie�H te copy if necessary - the work covered by this request:
v�r� r
GENERAL FEES Outdoor Liqhtinfl Standard (� $1
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device w Apparatus @$.50
ADDITIONS TO THE GENERAL I
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units (d $50 Per Unit
LighGng Retrofit @ $.25 per Fixture
Center Pivot Irriaation Boom � 84L
Mile
I�I ��I ��l II I� II III � 111 II Iil il III II I� i I�i
L 7 6� S 2 0 7
ONE & TWO FAMILY DWELLINGS, EACH UN1T
Includes fhe Senice andlor Power Supply up to 500 Amperes, All
Cirouits and Tvro Inspection Trips Each Dwelling Unit @$80
TOTAL FEE I
(minimum total fee is $20) 2a•6Q
Tw5 MEA Fq21N5PELi0R 115E pYV
I hereby certify tlwt I inspected tlie elethical installation desCribed herein on the dates sta�d:
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Request Date: Rough-in Inspection Required? ❑ Yes Inspectia� OtherThan Rough-In: ❑ y Now � Will Call
�?��� You must call the inspecla when ready! Date Ready.
I certify that I am the �ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and he�eby request inspection of the electrical work at:
INSTRUCTONS ON BACK OF YELLOW COPY � BOARD OF ELECTiICITV CAPY EB-00001M14 8.7. 2002