P - 78247REQUEST FOR ELECTRICAL INSPECTION
1� 4,•6 0— 8 6 7 � Minnesota Board of ElecUicity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
, (651) 642-080011Y/MRS 1-800�27-3529 www.electricity.state.mn.us
❑ NEW 0 REMODEL ❑ ADDITION REPAIR Describe -using�e back of the white copy 'rf necessary - the work covered by this request:
y > .vl�U/<<.o
GENERALFEES
SUPPLIES .
0 to 400
401 to 8�
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aooaratus � 5.50
Traific Signal Standard
Supplemental Fee @ $
Transformers uo to 10 I
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwellir�g Unit @$80
.LINIiJ YtK UNI I TOTAL FEE I �
S50 Per Unit (minimum total fee is $20) �� sG
U�i1 �$25 Tws naEn Fae ir�srECrat usE ari�r
I he2by certi(y tl�at I inspected tlie electrical insiallation described herein on ttie dales 5fa0ed:
OTHER ADDITIONAL FEES /� ��, /, / o- �-ej� q �/
C� $.25 Der Fixture /I!!� /0 2�.'7 - �i �� �� � ( Q O
Lots
Hour
i I�� II (II (I III II III II III �I III II III II II) �� I�
1 4 6 0 8 6 7 3
2 -%� -c%'>
OMPLETED WITHIN 12
� •.! R.D !�A �.!
o� �Q �1 ' C,�l ��' �J '� �S �
Request Dale: Rough�n Inspedion Required? ❑ Ves �No Inspaction Other Than Rough-In: OReady Now �+VY�II Call
�� /� ��� You must call the inspector wF�en ready! Date Ready:
I certify that I am the �UCENSED CONTRACTOR ❑COMPANY ❑ OWNER and hereby request inspection of the electrical work at: