P - 79090T
1-�35-249 �
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❑ NEW ❑ REMODEL ❑ ADDITI N❑ RE
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GEI ERA FEES
REQUEST FOR ELECTRICAL iNSPECTION �
Minnesota Board of Electricity � -
1821 University Avenue Suite S-128, SaiM Paul. Minnesota 5510�
(651)642-0 RS 1-800-627-3529 www.electriciry.state.mn.us
R Descri - ack of the white copy 'rf necessary - the work covered by lhis request:
utdoor Llahtina Standard � $1
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or aratus E.50
ADDIiIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units @$50 Per Unit
Each Addi6onal Unit � $25
to 10 KVA � S10
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service �dla Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$60
(minimum total fee is $20) � ��
rres u� wa vnaEC,«t us� aa.
1 hereby ce�ti(y tl�at I inspec�d lhe dec6ical i�fallation described hwein on tl�e da4es staled:
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� THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NoT cvMP�e i tu w� � rnn ic envn � na
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� _ D f�gh-in Inspeclion Required? Yes Inspedipn p�her Than Rnugh-In: Now II Cell
"' You must call the inspector when ready! paie Ready: ," f
I c�erdy tliat I am the ❑ ENSEQ CONTRACTOR ❑COMPANY ❑ OWNER ar�d he�eby request nspaction d 0►e eleetric�l wak at:
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