P - 76241� REQUEST FOR ELECTR,�,�-,4L I�iSPECTION �'�
1�� ��� 9 � Minnesota Board of Electricity �
1821 Universfty Avenue Suite S-128, Saint Paul, Minnesota 55104
. 5651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
Descn'be -using the back of the white coPY if nec�ssary - the xrork cove by this r�u
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401 to BQO
ALARM, WMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or A s@$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DVdELLINGS (PER UNlll
I THIS
Boom
Mile
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18202895
1°`tl' � / " ] / � �ough-in Inspedton R�uiredl ❑Yes
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l � You must cell tha inspector when readyl
I certify that I am the � UCENSED CONTRACTOR ❑ COMPANY
Job Site � �� � � � � � � �1/
or
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ON BACK OF
Traffic Signal Standard @ $5
Supplemental Fee @ $ZO
Transfwmers u� to 10 KVA $10
Transformers over 10 KVA $ 20
Transformer / Power Su I for Si ns / OuUine Li htln $5
ONE � 1W0 FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, AII
Circuits and Two Inspa.fion Trips Each DwelGng Unft @$80
TOTAL FEE
total fee is $20)
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d the electrical UistallaUon dagalbed herein on the dat� ateted:
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IF NOT COMPLETED WITHIN 12 MONTHS
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Inspection Other Than Rcugh-In: ❑ Ready Now Cep
Date Ready.
and hereby request inspedion of the electrical wrork at
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Contrador Llcer�se Numbar Master Electridan or P
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