P - 76343REQUEST FOR ELECTRICAL INSPECTION , I: '
L� aL �F �� 4 4 0 0 Minnesota Board of Electricity (/
1821 U iversity Avenue Suite 5-128, Saint Paul, Minnesota 55104
�6�2-0800TTY/MRS 1-800-627-3529 www.electricdty.sJate.mn.
0 to 400
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ALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Apoaratus (m $.50
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Fee
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each DwelGr�g Unit @$80
Additlonal Ir�spec�on Trips @ $20
Irnestiaative Fee
total fee is
� nerenr �ertity tnat � �nsaeded tne el�el
dafes
S 'al Ir�spection $.31 r Mile
THIS INST/1LLATION MAY BE ORDERED DISCONNECTED IF NOT COIIAPLEiED WITHW 12 MONTHS
r GR ? �� f �CE US6 �>NL ;
I�II�I�U��IIOIIIIiIIIl6II�I�III��I� �C'D MAY �4 200i
21444401
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�� � Rough-in Inspectlon Required? ❑ �pactlon Other Than R ugh-In: dy Now OWqI Ca0
You must call the inspedor when readyl Da[e Ready.
I certify that I am th ENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work afi
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�Master Electrician or Power
Licenae Number
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