P - 79253REQUEST FOR ELECTRICAL INSPECTION
,�� 1 � O- 6 4 8� Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
NEW ❑ REMODEL ❑ ADDITiq� _ O j3�p��Q Q�sc�,-�(I�g b�pkQj,3pg�ite copy if necessary - the work Covered by this request:
POWER SUPPLIES
Above 800
;UITS I FEE
0 to 200 Ar
ALARM, COMMUNICATI REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS �ESS THAN 50 VOLTS
Each S stem vice or aratus $.50
ADDITIONS TO THE GENERAL FEES
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
� II�I Il �I 11 Ifl N IN II 111 Il� fl III II {N II I� I Inl
177[l6 482
Fee @ $20
iotal�KVA�$1�
� Transformer I Power Supply for Siqns I Outline Lighting @$5
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 @$60
(minimum total fee is $20) � 24.50
iHIS AREA FOR INSPECTOR USE OKv
I heieby cerUty that I inspected the electrical installa6on described herein on Me daBes stated:
% �d
INECTED IF NOT COMPLETED WITHIN 12 MONTHS
_
R4699
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Request Dffie: Rough-in Inspeclion Required? [� Yes �I�o Inspedion O[het Than Rough-In: L1Ready Now LJ 44NI Call �
Q?��� You must call the inspedor when ready! Date Ready:
I certify that I am the d�{.ICENSED CONTRACTOR �COMPANY ❑ OWNER and hereby request inspec:tion of the elechical work at:
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