P - 78880REQUEST FOR ELECTRICAL INSPECTION
1� U� O- 411 � Minnesota Board of Electricity
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
(651) 642-08Q0 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
❑ NEW 0 REMODEL ❑ ADDITION PAIR Describe -usin the back of the white copy if necessary - the work cove2d by this request:
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ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A atus $.50
ADDITIONS TO THE GENERAL FEES
to 12 Units �$50 Per Unit
ach Additional Unit � $25
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16704116
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I certity tliat I am tt�e
Traffic Si nal Standard $5
Su demental Fee $20
Transfortners u to 10 KVA $10
Transformers over 10 KVA E 20
Transfortner I Power Su I for ' ns I Outline L' htin ;5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Txro Inspection Trips Each Dwelling Unit �$BO
Inves' ativeFee
Reins tion Fee $20
TOTALFEE
(minimum total fee is $20) � 0 e �
iH15 MFA FIXt IlLSPECTpI USE OKY
I hereby certify thffi I inspec@ed the elecbical i�talla6on described haein on the daks st�ed:
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Rough-in Inspection Required? ❑ Yes No �nspection p�her Than RougMn: eady Now � VWII Call
You must call the inspector when ready! p� �Y ��3
NSED CONTRACTOR ❑COA�ANY ❑ OWNER and hereby request inspection of tt�e electrical work at::