P - 77454REQUEST FOR ELECTRICAL INSPECTION
1� 6 7 6- 5 9 5� Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
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�� (651) 642-0800 TTY/MRS 7-800-627-3529 www.electricity.state.mn.us
❑ EW ❑ REMODEL ❑ ADDITION ' REPAIR Describe -using the back of ihe white copy 'rf necessary - the work covered by this request:
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GENERAL FEES Outdow htin Standard S1
40110
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A aratus $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
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ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes ihe Service �dlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
TOTAL FEE I �
(minimum total fee is $20) p� � '—
TH�s nnEn vaa iraaECTOa usE aar
I he2by certify that I inspecled the electrkal insqll�on desuibed herein on the dales sfated:
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