P - 76243REQUEST FOR ELECTRiCAL INSPECTION
1������ 5 6� ��nnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
L651) 642-OS00 TTY/MRS 1-800-627-3529 www.electricity.state.mn.
D ing the back o�e wlut• e_copy 'rf nec�ssary - the work covered by this request:
POWER SUPPLIES
ALARM, COMMUNICATION, REMOTE CONTROL, SIG
CIRCURS, CIRCUITS OF LESS THAN 50 VOLTS
Each S m Device or Apparatus Q$.50
ADDITIONS TO THE GENERAL FEES
Traffic Sianal Standard
Transfarmers over 10 KVA a$ 20
Transformer / Pawer Supply far Signs / OuUine
ONE & 1W0 FAMILY DWELLINGS, EACH UNR
Includes the Service and/ar Power Supply up�
Circuits and Two Ir�spection Trips Eac
Additional Ins�Uon Trios l�a $20
$e0 � O D I
I IhAMILT UWtWN�iS F'tK UNII TOTAL FEE s
3 to 12 Units @$5o Per Unit (minimum total fee is $20) �<' '��
Each AddfUonal Unit @$25 �y,lo ta o s-d� - S?'a�'¢�.'�CT0R1��Y
OTHERADDRIONAL FEES l'� 1 � � - �S`�7
Lighting Retrofit @$25 per Fature I hereby certrty that I mspeded the eteadral instaVaBon descnbed herem on the dat� sta0ed:
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LATION INAY BE ORDERED D
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18204560
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IF NOT COMPLETED WRHI 1'MONTHS
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I� , r,,. � I Rough-fn Inspectlon Required9 ❑Yes ❑ No Inspec4fon Ofher Than Rough-In: � Ready Now � Wip Call �
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�/ �__� You must call the Inspedor when ready! Dete Ready.
I certify that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY �OWNER and hereby r�uest inspection of the electrical work at
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CoMrAdor Li nse NumEier Master edrician or Power Lim
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or �c�pp2ing Ir�sta tlon) �
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r Perfortnirtg I Please P vid�—
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