P - 77634REQUEST FOR ELECTRIC�L INS ��SI,ON
���-F'� - 9 4 4�3 Minnesota Board of Electrici y v�,�'^ av�+1 -
1821 University Avenue Suite S- 28, Sa rt�aul, Minnesota 55104
(651)642-OBOOTTY/MRS 1-800-627-3529 www.electriciry.state.mn.us
❑ NEW EMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
��4-I�C S�- _ �(f C� �o,.� _. �a�fl �%t,iro C
SERVICES I
AtARM, COMMUNICATION, REMOTE CONTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL F
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units (a,l $50 Per Unit
Exh Additional Unit (til $25
THIS
n Boom $4(
Park Lots S
Paric Sites
s tion $2
! 530 cer Fbur
Ilil IIIII IIIII II!!I IIIII Il1il IIIII Ilill �� I�
15419443
Outdoor Ligh6ng Standard @ $1
Traffic Sianal Standard � S5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Reins 6on Fee $20
L � TOTAL FEE
rnnimum tofal fee is $20)
iN15 MFA FOR INSPELTOft U$E Q"LY
I hereby cer6ry that I inspec0ed the electrical installa6on deuribed herein on the da�s staled:
�
IF NOT
-- s-G G
Keque;t uate: Rough�n Inspection Required? ❑ Yes �No Inspedion Other Than RougMn: ❑Ready Now,s'CYill Call
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('�� 7� You must call the inspector when ready! Date Ready:
I certify that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of tlie electrical work at: