P - 78888^ REQUEST FOR ELECTRICAL INSPECTION
� � � �� � � � � �, Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
r (651) 642-08Q0 TlY/MRS 1-800�27-3529 www.electricity.state.m .
❑ NEW ❑ REMODEL ❑ ADDITION REPAIR Desbribe -u ' the back of the white copy if�essary - th rk covered by this
f_GIJFRAI FFFC Outdoor Liahtina Standard Ca� $1
0 to 2(10 Am re $5
Above 200 Am re $10
AIARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or atus $.50
ADDITIONS TO THE GENERAL FEES
Unit
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Grcuits and Two Inspection Trips Exh Dwelling Unit �$80
Fee
TOTAL FEE �D � �U
(minimum total fee is $20)
iM5 MEA F01i V15PECTOR USE 011Y
1 hereby cer6y that I inspected the elechical installa6on desaibeO herein on Me da�s st�d:
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of the electrical work at: