P - 78932cC REQUEST FOR ELECTRICAL INSPECTION
1� V IJ �- 4 5 8� Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Sairrt Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-G27-3529 www.electriciry.state.mn.us
EW . EL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy'rf necessary - the work covered by this request:
SERViCES I
ALARM, COMMUNICATION, REMOTE CONTROI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device w Aouaratus � 5.50
3 to 12 Units � $50
Each Additional Unit
HOUf
FEES
(I�) II III II III II I�I II I�I II I�� II II) II I�I 11 � I IIII
1 6 5 7 4 5 8 4
TraRc
� Trarisfortners over 10 KVA � S 20
� Transfomier / Power SuDPIy for Signs I Outline Lighting ;5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Suppty up to 500 Amperes, All
Grcuits and Two Inspection Trips Each Dwelling Unit �$80
Inves' ative Fee
Reins ' n Fce $20
TOTALFEE ��
(minimum total fee is $20) Q� �.i i�
TMS MEA FOR WSPECTpt USE d1Y
I herebY ceNfy tl�at I inspecOed the dxtrical instaAation described herein on the da�es s�Bed:
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'�V'+�� "�e� Rough�n Inspection Required7 ❑ Yes No Inspedion Other Than RougMn: dy Now � Will Call
%,���} � You must call the inspedor when readyl Date Ready:
I cer6Ty Uiat I am tlie �ICENSED CONTRACTOR ❑CON�ANY ❑ OWNER and hereby request mspection of ttie electrical work at: