P - 79277REQUEST FOR ELECTRICAL INSPECTION
��`' 1� J- 5 2 4 0 Minnesota Board of Electricity -
1621 University Avenue Suite S-128, Saint Paul, Minnesota 55104
,. (651)642-OBOOTTY/MRS1-S00-627-3529 www.elec[riciry.state.mn.us
NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy it necessary - the work covered hy this request:
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GENERALFEES
! POWER SUPPLIES
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
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Traffic Sianal Standard
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two InspecGon Trips Each Dwelling Unit @$80
(minimum total fee is $20) � ��� ��fl
iH15 AREAfOfI INSPFCiGR USf ON.Y
I here6y certify thffi I inspectad the electrical installalion deuribed herein on tbe da[es stated:
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Request Date: Rough-in Inspection Required? Yes Irupection Other Than Rough-In: �Rbady Now � V1rll C8U I
Q� f`�Q f[JQ You must call the inspector when reedy! Date Ready.
i certify that I am the C�ICENSED CONTRACTOR ❑COMPANY [7 OWNER and he�eby req�st inspectia+ of ihe electrical work at::