P - 78104REQUEST FOR ELECTRICAL INSPECTION
1� 5 3 3�� O� � Minnesota Board of Electriaty
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
, (651) 642-0800 TTY/MRS 1$00-627-3529 www.el¢Ctricity.stat¢.mn.us
❑ NEW REMODEL ❑ ADDITION ❑ REPAIR Describe -using the bxk of the white copy if necessary - the work covered by ihis request:
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GENERAL FEES Outdoor Li�htinp Standard � Si
SUPPLIES _
ALARM, COMMUNICATION, REMOFE CONTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aonaratus O 5.50
Traffic
ONE b TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$60
I IYNMILT UWtLLINIiJ rtK uni i • - � TOTAL FEE �
3 to 12 Units @ g50 Per Unit (minimum total fee is $20) ��,
E2Ch Adtliti0n21 nit �$25 '"� ^�" F� "+s��T� � aar
I hercby ceNy tl� 1 inspecbd the elechical install�on desaibed herdn on the daks sta�d:
^ ' OTHER ADDITIONAL FEES N�. Z—$� j`—cri�E D T
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�I � Rough-in Inspedion Required? LJ Yes � No Inspedion Other Than RougMn: �Ready Now �WW Cal�
`p�lQ You must call the inspeclor when readyl Date Ready:
I certify that I am the �,LICENSED CONTRACTOR ❑COIi�ANY ❑ OWNER and hereby request inspec,iion of ihe electrical work at:
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