P - 77309REQUEST FOR ELECTRIGAL INSPECTION
1— 7 0 9- 9 3 7� Minnesota Board of Electriaty
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800�27-3529 www.electriciry.state.mn.us
O NEW O REAAODEL 0 ADDITION ❑ REPAIR Desc�be -using the bxk of the wh fe copy rf necessary - the work covered by this request:
iM, COMMUNICATION, REMOTE CONTROL, SIGNALING
;UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparalus � 5.50
ADDITIONS TO THE GENERAL FEES
TIFAMILY DWELLINGS PER UNI
3 to 12 Units � S50 Pet Unit
Each Additional Unit @ S25
I Retrofit � E•25 per Fixtu�e
Pivot Irtia�on Boqn @ f4(
IIII 11III II I�� IIIII IIII� I�I�I IIIII IIIII �� I�
L7099375
Sfandard
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes ihe Service andlor Power Supply up to 500 Amperes, All
Grcuits and Two Inspection Trips Each Dwelling Unit @ S80
( TOTAL FEE I .�� /!� � Q
minimum total fee is $20 ��►
TltlS NiEA FOR RiSPECTdt
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�- v(�-A You must call the inspedor when ready! Date Reedy. .
I cefify that 1 am Cie I�fCENSED CONTRACTOR ❑ CON�ANI' � OYIMER and hereby request inspection of 1he electrical work at:
Job site ndarass (street eox or Rouoe No.) Ciry T�v code
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