P - 79763� REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
1-396-555 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
` (651) 642-OS00 TTY/MRS 1-800-627-3529
www. electricity. state. mn. us
Identify the work covered by this request:
U NEW ❑ REMODEL Q ADDITION ❑ RePaia x�EL ENER�Y SAVER'S SWITCH
ALARM, COMMUNICATION, REMOTE CONTROI, SIGNALING
C�RCUITS. CiRCUITS OF LESS iHAN 50 VpLTS
Each System Device or A paratus �$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS (PER UNI�
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
OTHER ADOfTIONAL FEES
Li htin Retrofit �$25 per FixEure
Center Pivot Irri tion Boom �$4
Manufactured Home Park Lots �
to 10 KVA
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circutts and Two lnspection Trips Each Dwelling Unit �$P
Additional Insuection Trins � $20
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TOTAL FEE
total tee is $201
I hereby certify that I inspected the eledrical installation described herein on Me detes s[ated:
ROUGHIN OATE
FNJAL INSPECTION DATE
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FOR OFFICE USE ONLY
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Heques1 /� Rough-in Inspection Re uired?
Q ❑ Yes I'�No Inspection Other Than Rough-in: Ready Now ❑ Will Call
You must call the inspector when reatly! Date Ready:
I certify that I am tt�e � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Addressdfireer, Bo�i�q�gllYly'1 � v� � ��b'
VlJO 71'1 F�f� Zip Code ��r,�„�
Sectlon Township Range Fire Na.
County
Occupg�rtN�N JENNIFER O O�� Pho�e
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�Power S DDIIB{ Address
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e1����`'�,���'�RP�ORATI4NV
ConVactor Lic�pgey�y�
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Meiling q�����i ���t,o�N 55114
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Authodze ' nature { Vacf Companv.or Owner PeAortning Installafron) p
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EB-OpOp�A �3 . ����2000 80ARD OF ELECTRICITY COPY
Number
B51 �96-2�11 I
INSTRUCTIONS ON BACK OF YELLOW COPY