P - 781811[ REQUEST FOR ELECTRICAL INSPECTION ��
1� J��— 0 5 3� Minnesota Board of Electricity
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
" (651)642-080011Y/MRS 1-800-627-3529 www.electricity.state.mn.us
❑ NEW REMOD ❑ ADDITION ❑ REPAIR Desaibe -using lhe back of the white copy 'rf necessary - the work covered by this request:
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401 to B00
ALARM, COMMUNICATION, REMOTE CONTROI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device w aratus 5.50
ADDITIONS TO THE 6ENERAL
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units B S50 Per Unit
Lighting Retrofit
Center Pivot Irr�
Tr�sfwrners u to 10 KVA $10
Transformers over 10 KVA � S 20
Trar�sfomier / Power SuDdY for Signs I Outline Lightina $5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes ihe Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit � E80
Additional Inspection Trips @ $20
Investigative Fee
ReinsDection Fce � E2(1 �!
(minimum total fee is $20) �' �
T/XS AREAfdt RSPECiOR USE QLY
I hereby cer6fy tl�at I inspected the electrical insfallaEOn desaibed herein on the dates sf�ed:
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Req Dffie: Rough�n Inspedion Required? ❑ Yes �ns
� peUion Oth� Than Rough-In: ❑Ready Now VYNI Call
�j �i � You must call the inspecta when ready! Date Ready:
I certiy ihat am the ICENSED CONTRACTOR ❑ COIuuPANY ❑ OWNER and hereby request inspe�fion of tl�e electrical wak at:
Job Site Address iSVeet �X or Fioute No.)
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supp�ier Adaress
Contracta License Number Master Electrieian or PaNer Limited TecFnician
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