P - 770261-922-380 ❑9
I Describe -us,ing the�back of the white
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� SERViCES / POWER SUPPLIES
0 to 400 Amoere na. $25
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL I
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
FEES
Hour
THIS INSTALLATION MAY BE ORDEI
REQUEST FOR ELECTRI AL INSPECTION �``�
��� �,
Minnesota Board of Electricity ��Q,� Qo�� y �- �
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �
(651)642-OSOOTTY/MRS 1-800-627-3529 www.electricity.state.mn.us ����
-�ie work covered by this request:
IIII I) (II II III II III II III II III II (II II III �� I�?
L9223809
Outdoor Liqhtinq Standard
Transformers over 10 KVA $ 20
Transformer / Power Su I for Si ns / Outline Li htin $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additional Ins ion Trips $20
Investi ative Fee
Reinspection Fee $20
TOTAL FEE •�D ` �"`�
(minimum total fee is $20) JV
THIS AREA FOR INSPECiOfi USE ONLV
I hereby certify that I inspected the electnral installation described herein on the dates stated:
D-
COMPLETED WITHIN 12 MONTHS ___� J
A
uate: Rough-in Inspection Required? ❑ Yes �No Inspection Other Than Rough-In• �Ready Now ❑ Will Call
/Q�r'� 7 (j� You must call the inspector when ready! Date Ready: /�y/Q�
I certify that I am the �LICENSED CONTRACTOR � COMPANY ❑ OWNER and hereby request inspection of the electrical work at: