P - 78161REQUEST FOR ELECTRICAL Ily,$PE�T�O�V�
1— J Q 1� 0 8=F � Minnesota Board of Elecficity �' %
v 1821 University Avenue Suite S-126, Saint Paul, Minne�ota 55104
` (651)642-OSOO�YMARS 1-800�27-3529 www.electriciry.state.mn.u.s
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❑ NEW' ❑ REMODEL 0 ADDITION �tEPAIR Describe -usin of ihe white copy �necessary - the work cove�ed by this request:
� Above 200 Ampere @$10
AIARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device ar Aooaratus Cd $.50
Su lemental Fee $20
Transfortners u to 10 KVA $10
Trarisformers over 10 KVA $ 20
Transformer / Power Su I for Si ns I Outline Li h6n $5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes lhe Service andlor Power Supply up to 500 Amperes, Ali
Circuits and Two Inspection Trips Each Dwelling Unit �$80
Additional Inspection Trips @ $20
Investiaffiive Fee
MULTIFAMILY DWELLINGS PER UNIT TOTAL FEE f s
3 to 12 Units @$50 Per Unit (minimum total fee is $20) ��
EaCh AddiGonal Unit �$25 Tws u�n Foa nasaECroa usE orxr
I hereby certiry Nat I inspected Me electrical installation described herein on Me dates stated:
OTHERADDITIONALFEES �. �.�Y<'i GL'�[
Lighting Rehofit @$.25 per Fi#ure �� 2 /^U( � f�
Hour
Mile
I Ial � I!I II III II III II III II III II III II III �� I�I
15870843
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MPLETED WITHIN 12 MONTI
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Request Dat Rough-in Inspection Required? ❑ Yes Inspection Other Than Rough-In: ❑Ready Nav II Call
!j You must call the inspedor when ready! Date Ready:
I certify t I am the ❑ LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at::
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E&00001M14 8.7.2002