P - 78212REQUEST FOR ELECTRICAL INSPECTION
1 ��CJ � 1- 5 0 4� Minnesota Board of ElecUicily -
��,- 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
i•�`'� _?' "` (651) 642-0800 TTY/MRS 1-800�27-3529 www.electricity.state.mn.us
❑ NEW 0 REMODEL �ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
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GENERALFEES
SUPPLIES
to 400
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or atus $.50
ADDITIONS TO THE GENERAL FEES
Outdoor Liqhtina Standard
0
J 7ransfortner I Power SuDDIy for Signs / Outline Lightinq $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Pawer Supply up to 500 Amperes, All
Circuits and Two Inspecfion Trips Exh Dwelling Unit @ S80
_LIIYUJ rCR UIVI I TOTAL FEE �c?
S5o Per unit (minimum total fee is $20) �� �
Unit @$25 Tws u�r, Fort rca�croa usE «ar
I hereby certify that I inspeched the electrical installaGon described herein on the dates sta0ed:
OTHERADDITIONALFEES � CGL� OGS "3 %Z
Lots �
Sites
on $2
cer Hour
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Request Date: Roughin Inspedion Required? Yes ❑ No Inspecfion Other Than Rough-In: Ready Now ❑ Will Call
"G �� � You must call the inspec[a when ready! Date Ready:
I certify that I am 1he�ICENSED CONTRACTOR ❑COMPANY ❑ OWNER and hereby req�st inspection of the electrical work at::