P - 78442_ �.
REQUEST FOR ELECTRICAL INSPECTION
1�� � 3 1� 0 7 2 � Minnesota Board of Electricity
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104 `
� �"�/� (651) 642-OB00 TTY/MRS 1-800�27-3529 www.electriciry.state.mn.us
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❑ NEW EMODE ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
�C� G�Ccv n S —%%�� %
GENERAL FEES Outdoor Liahtina Standard (d $1
0 to 400 Ai
401 to 800
Above 800
CIRCUITS I FEI
ALARM, COMMUNICATION, REMOTE CONTROL, SIGI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or A'pparatus @$.50
ADDITIONS TO THE GENERAL FEES
12 Units @ $50 Per Unit
i Additional Unit � $25
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Txro Inspection Trips Each Dwelling Unit @$80
(minimum total fee is $ZO) � �t,T"✓
TKSNiEAFpiPSPECTIXI Ot1Y
I hereby cer0y Mal I inspected tlie electric� insta&ation desaibed herein on tlie da�s sfated:
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THIS INSTALLATION MAY BE ORDEREu .;��� NECTED IF NOT COMPLET�WITHIN 12 MONTHS
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Request Date: Rough-in Inspection Required7 ❑ Yes No Inspedion Other Than Rough-In: �Ready Now II Cail
`���� You must call tlie inspector when readyl Date Ready:
I certify that I am the � ENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the elechical work at:
�NS�rtucnons ow swcu oF reuow covr BOARD OF ELECTRICT' CAPV eerww,�-„ a.,. �