P - 77998REQUEST FOR ELECTRICAL INSPECTION
1� 5 3 8- 9 6 9� Minnesota Board of ElecVicity
. 1821 University Avenue Suite S-128, Saint PaW, Min�esota 55104
, (651) 642-0800 TTY/MRS 1-800�27-3529 www.electricity.state.mn.ur
❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR Describe -using the bxk of ihe white copy'rf necessary - the wak covered by this request:
Remodel distribution Center
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Exh S stem Device w �us i.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units @ S50 Per Unit
Each Additional Unil � $25
OTHER ADDITIONAL FEES
Liahtino Retrofit O 8.25 cer Fixture
Traffic
Fce
Transfortners u to 10 KVA St0
Transfomiers rner 10 KVA S 20
Tr�sfortner I Power Supply for Signs I Outline Lighting � a5
ONE � TWO FAMILY DWELLINGS, EACH UNIT
Includes fhe Senice andlor Power Suppiy up to 500 Amperes, PJI
Circuits and Two Inspec6on Trips Each Dwelling Unit @ S80
(minimum total fee is $20) � 3 9 0. 5 0
rres u� Fat xaaEC.oa usE «ar
I hereby certily that I inspected the electrical installa6on described I�erein on the dates staled:
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Request Dele: Rough-in Inspeciion Required7 Yes ❑ No Inspedion Other Than RougMn: ❑Ready Now I Call
3/ 31 / 0 4 Ya+ must wll the inspector when ready! Date Ready.
I certify that I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the elecUical work at: