P - 790981-69�-568�
❑ NEW ❑ REMODEL DDITION ❑
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1 POWER SUPPLIES
ALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device w Apparatus @$.50
ADDITIONS TO THE GENERAL
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$SD Per Unit
Each AddiGonal Unit @ $25
Center
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REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TfYIMRS 1-800-627-3529 www.electriciry.state.mn.us
� Describe -using the back of the white copy if necessary - the work covered by this request:
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Fee @ $20
�o to 10 KVA
ONE & TWO FAMlLY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each �welling Unit @$80
(minimum total fee is $20} �,/,7f ( j,
THIS AREA FIXi INSPECTqi US
I hereby ceAity that I inspec0ed the electrical insL�Wtinn described he�ein on the dates sUhed:
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rceq e: RougMin Inspection Required? U Yes Inspedion Other Than RougMn: �Ready Now Call
'� You must call the inspector when ready! Date Ready:
I certify that I am tt�e ICENSED CONTRACTOR ❑COMPANY � OWNER and hereby request inspection of the electrical work at:
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BOMD OF ELECTRICT' CAPV
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E8-0OODfA•t4 B.Y.2002