P - 78413REQUEST FOR ELECTRICAL INSPECTION
1� 4 9 7- 8 9 5 1❑ Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
� r� l-) �"",L (651) 642-0800 TiY/MRS 1-800-627-3529 www.electriciry.state.mn.us
❑ NEW �MODEL ❑ ADD TION ❑ REPAIR Describe -usi the b ck of the white copy if necessary - the work covered by this request:
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GFNFRAI FFFR Outdoor Liahtina Standard na. $t _
/ POWER SUPPLIES
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Apparatus @$.50
fIFAMILY DWELLINGS (PEI
3 to 12 Units �$50 Per Unit
Each Addi6onal Unit @ $25
Boom
Tf2ffIC
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up l0 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$60
Fee
TOTALFEE
(minimum total fee is $20) � as�
THIS MFA fqi INSPECTIXt USE ONY
I hereby certify that I inspected the ekctrical installation described herein on the dales �Oed:
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Request Date: Roughin Inspecfion Required? ❑ Yes �NO Inspedion Other Than Rough- n: ea y ow
�� `2,. ��3 You must call the inspector when ready! Date Ready.
i certiy that I am the �ICENSED CONTRACTOR ❑COMPANY ❑ OWNER and hereby request inspection of the elechical work ai: