P - 79246- REQUEST FOR ELECTRICAL INSPECTION
��� 1 O- 6 41 � Minnesota Board of Electriciry -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.staCe.mn.us
NEW ❑ REMODEL ❑ ADDITION _0 REPAIR Describe ;usin�ihe back of the white copy if necessary - the work covered by this request:
✓ICES /
0 to 400
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aooaratus �$.50
2 Unik @ $50 Per
Addi6onal Unit � 7
Standard
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$80
(minimum total fee is $20) I 20.50
THIS AREA Fdt IlBPECTOR USE p1Y
� hereby certify that I inspecfed the electricaf insfallation deuribed herein on Ihe da0es sm0ed:
_6
� ���� �� �� ��� �� ��I �� I�� �� �II �� ��� (� ��
������ �4699
1 7 7 D 6 4 1 7
�OD�i •6l��� � so
Request Date: Rough-in Inspection Required? � Yes ❑ Inspection Other Then Rough-In: ❑ eady Now � Will Call
�7��� You must call tlie inspector wh� readyl Data Ready:
I certify that I am the ❑?�ICENSED CONTRACTOR ❑COMPANY ❑ OWNER and hereby request inspection of the elecVical work at::
INSTRUCTONS ON BACK OF YELLOW COPY BOARD OF ELECTRICfTV COPV EB-00001A-11 8,7.2002