P - 77197- REQUEST FOR ELECTRICAL, INSPC�„TION
1� 412 �� o�� Minnesota Board of Electriaty
1821 University Avenue Suite S-128, SaiM Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800�27-3529 www.electricitystate.mn.ur
❑ NEW ❑ RE EL ❑ ADDITION ❑ REPAIR Describe -us the back of e white copy ii necessary - lhe work covered by this request:
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GENERAL FEES door ' hUn Standard =t
SERVICES / POWER SUPPUES c Sianal Standard �t 35
ALARM, COMMUNICATION, REMOTE CONTROL
GRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Eaoh System Device or Apparatus �$.50
ADDITIONS TO THE GENERAL
MULTIFAM�LY DWELLINGS PER UNI
3 to 12 Unik � E50 Per Unit
Exh Additional Unit � E25
OTHER ADDITIONAL FEE;
' htin Retrofit E.25 Fixlure
Center P'wot Irtioation Boom � S40_ _
Fbur
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Ir�cludes the Service andlor Power Supply up to 500 Amperes, All
Grcuits and Two Inspection Trips Each Dwelling Unit � S60
TOTAL FEE
(minimum total fee is $20) .Sd
nas u�, wn xaeECron usE aar
I herebr aAiy tlwt I inspeqed the dectical i�taYatlon desaibed hercin on tlie dabs staEed:
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Request Date: Roughin Inspecdon Required? ❑ Yes ❑ No Inspedion Olher Than Rough-In y Now � WNI Cell
' Q� You must call the inspeUOr when ready! pate Ready,
I cerMy that I am the �LiCENSEO CONTRACTOR ❑ COIuPANY 0 ONMER and hereby requPSt inspection of 1he electrical worlc at:
Job SRe Address (Street BoX or Route No.) City��" /J Zip Code
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