P - 78978REQUEST FOR ELECTRICAL INSPECTION
1 6 0 9- 2 4 2� Minnesota Board of Electricity �
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-OB00 TTY/MRS 1-800�27-3529 www.electriciry.state.mn.us
❑ NEW 0 REMODEL ❑ ADDITION REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
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0 to 400
ALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
3 to 12 Units @
Each Additional
Retrofit
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1609242L
TraTfic Sianal Standard
ONE & TWO FAMILY DWELLINGS, EACH UNI I
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$60
( TOTAL FE � I �,�j
minimum total fee is $20 �s� � �
THIS MEA FOR INSPECiOR USE ONLY
I hereby ceNry that I inspecfed tlie elecbical installa6on described herein on the d�es sta0ed:
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i oerti(y that I am the 1�1 IICENSED CONTRACTOR ❑ COMIPANY C] OWNER and hereby request insspection a� the eie�trical wak at: