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P - 780631-530-335 ❑7 ❑ NEW ❑ REMODEL ❑ ADDITION GENERALFEES SERVICES I POWER SUPPLIES ALARM, COMMUNICATION, REMOTE CONTROL CIRCUITS, CIRCUITS Of LESS THAN 50 VOLTS Each S stem Device or aratus $.50 ADDITIONS TO THE GENERAL f MULTIFAMILY DWELLINGS PER UNI 3 to 12 Units @$50 Per Unit Each Addifional Unit @ $25 OTHER ADDITIONAL FEES Liahtina Retrofit Cd 5.25 oer Fixture REQUEST FOR ELECTRICAL INSPECTION Minnesota Board of Electricity 1821 University Avenue Suite S-128, SaiM Paul, Minnesota 55104 (651) 642-08Q0 TTY/MRS 1-800�27-3529 www.electrici �Cte�.us �, Describe -u in the back of the white copy 'rf e�sary - t e o c this request: � Traific Si nal Standard $5 Su lemental Fee $20 Transformers u to 10 KVA $10 Tr�sformers over 10 KVA $ 20 Transfortner I Power Su I for Si ns / OuUine Li htin $5 ONE & TWO FAMILY DWELLINGS, EACH UNIT Includes the Service and/or Power Supply up to 500 Amperes, Ali Circuits and Two Inspection Trips Each Dwelling Unit �$80 (minimum total fee is $20) � �J . �U iM5 MEA FOR INSPECTIX3 u5E CfAv I hereby certi(y that I inspected the electrical installa6on described herein on the dates sfated: �--c y � S ial ins 6on $.31 r Mile -" THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS IIIIIIIIIIIIIIIIIIiIIIIIII�IIIIIIIIIIIIIY�I� -��� L5303357 �� o�G� �p Req e: Rough-in Inspection Required? ❑ Yes Inspection O[her Than Rough-In: y Now ❑ Wfll Call You must call the inspecta when ready! Date Ready: I certify that I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of ihe electrical work at:: Job Sile Address (Strae BoY. or fioute PIo.1 � Cib � • TD Code __.. _ a ri��,., � �� mascer GecuMaan or License Number �"S y� v� - vvv�R.r �-c� � �jci INSTRUC710NS ON BACK OF YELLOW GOPY BOARD OF ELECTRICITV COPV EB-00001M14 8.1. 2002