P - 77445�
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REQUEST FOR ELECTRICAL INSPECTION
1.J � 2 0 7 � Minnesota Board of Electricily
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-08Q0 T7Y/MRS 1-800�27-3529 www.e[ectricity.state.mn.us
❑ NEW EMODEL ❑ ADDITION ❑ REPA�jIR Describe -using the ba/ck of the white copy if necessary - the wo covered by this request:
! 1 � � 'i� /� L / �-(JVr �i'T.(.�( � � __
ALARM, COMMUNICATION, REMOTE CONTROI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus � 5.50
ADDITIONS TO THE GENERAL
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units @$50 Per Unit
Each Addition� Unit � SZS
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Outdoor Li htin Standard $7
Traffic Signal Standard @ E5
Su lemental Fee E20
Tr�sfartiers u to 10 KVA E10
Transfortners over 10 KVA b ZO
Tr�siormer I Power Su for S' ns / Outline Li htin $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
(minimum total fee is $20) I yC -��
TNIS FFiA FOR INSP.ECT00. USE ONLY
1 hereby ceN(y th� I inspected the electrical installation descnbed herein on the dates sfakd:
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