P - 75694REQUEST FOR ELECTRICAL INSPECTION -
����� 3 6�� Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
�q `",� (651)642-0SOOTTY/MRS 1-800-627-3529 www.electriciry.state.mn.us
D�scn'be -using ck of the x+hRe copy'rf necessary - the work covered by this request:
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I SERVICES / POWER SUPPLIES
ALARM, COMMUNICATION, REMOTE COPITROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or AoaaraWs C� $.50
Each Additional Unit @
OTHE
uanhrm ReVofit co� $z:
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21473608
Fee
Includes the Service andlor Power Suppty up to 500 Amperes, An
Circuits and Two Inspection Trips Each Dweliing Unit @$80
Fee @ $20
TOTALFEE
iimum total fee is $20)
I hereW certKv tl�at I 6usneded the electrical 6�Ilafion desrr�'hed herefn an Um dat� slated: I
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IF NOT C�MPLETED WITHIId 12 MOWTHS
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�� Rough-in Inspedion R�uiredT ❑Yes �to Inspec2ton OtherThan Rough-In: ❑ Ready N�WID Ce0
� l��� You must ceU Mre inspador when readyl Da6e Ready.
I certity that I am the �,TICENSED CONTRACTOR ❑ COMPANY ❑ OINNER arid hereby request ins�ction of the electrical work at
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