P - 790871-62?°016 �
❑ NEW ❑ REMODEL ❑ ADDITION
SERVICES! POWER SUPPLIES
0 to 400 Am ere $25
401 to 600 Am ere $50
Above 800 Am re $75
IiSIFEEDERS
� 0 to 200 Ampere @ $5
� Above 200 Ampere @$10
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
MULTIFAMILY DWELLINGS PEI
3 to 12 Units @$50 Per Unit
Each Addi6onal Unit @ $25
REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity �
1821 University Avenue Suite S-128, Saint Paul, Min 5104
(651) 642-0800 TTYIMRS 1-800-627-3529 !e ' 'ty. ate.mn.us
2 Dgscnbe -using back of th� ite copy if nece;sary - vered by this request:
�) l / /1 D % /'e 1
� i/ f/ r.c., ri� (.C_ o'
Outdoor Li h6n Standard
Traffic Si nal Standard $5
Su lemental Fee $20
Transfortners u to 10 KVA $10
Transfortners over 10 KVA �$ 20
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16220162
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ReQ �ate: Rough-in Inspection Required? ❑ Yd
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You must call the inspedor when readyl
I certify that i am LICENSED CONTRACTOR OMPAI
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JobSiteAddress (Stree� or Route No.l Citv
e
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, Ail
Circuits and Two Inspection Tnps Each Dwelling Unit @$80
Addilional Ins tion Tri $20
Investi alive Fee
Reins tion Fee $20
TOTAL FEE � /^"�
(minimum total fee is $20) `�.J
,wsna�nF«+vucEC,a+use«.r
1 hereby cerGy tl�at I inspecled the electrical installafion described herein on tl� d�s stated:
-�� 3 �3 �.
��_�o�ay �o..�o
pecdon Other Than h-I . ❑ VNII Call
Date Ready.
❑ OWNER and hereb request in pection the electrical wak at:
ua�ua - wrnpany rvame I:OnV2CtOf LICBII3C IVU1f
wI �-- �.t,L1�CL "
AAeilin9 �( Ctor, Com aOwner /�n9 klsta/Aa}jon) ��
Q�
Authorized Signa r, Compeny or ing Installation)
. �
INBTRUCTONS ON BACK OF 11ELLOW C eo,wo oF �crnicm covr
/
Masier e�,vivan a
License Number
'/�. �l-�� � I
EB-00001M14 8.1.2002