P - 77736'] REQUEST �OR EL�CTRICAL INSPECTION
1�� � 1- 6 4 8❑7 Minnesota Board of Electricity
� L/�-y�j�� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
��/ (651) 642-0800 T'fY/MRS 1-800�27-3529 www.electricity.state.mn.us
❑ NEW ❑ REMODEL 0�4DDITION REPAIR Describe -usin� the back M ihe white copy'rf necessary �he work covere� by this request
r».is;. _i ..., _ . _
GENERAL
dICES / POWER
0 to 400 Amcere
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus $.50
ADDITIONS TO THE GENERAL F
MULTIFAMILY DWELLINGS PER UNIT
3 to t2 UniYs @$50 Per Unit
Each Additional Unit @ $25
5 r Fi�ure
Boom � S4(
I� ��I �III IIIII IIIII I�I�I IIIII �IIlI �� I�
14376487
� Transfortners up to 10 KVA $10
� Transformers over 10 KVA �� 20
Transformer I Power Supply for Signs / Outline Lightinq $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Senice �dlor Power Supply up to 500 Amperes, All
Circuits and Two inspec6on Trips Each Dwelling Unit �$80
Addi6onal Inspection Trips � $20
Investioative Fee
TOTALFEE
(minimum total fee is $20) ,����
THIS MEA Fqi INSPECTpi USE dAY
I hereby certify that I inspected the ek�ctrit� insfalla6on described herein on the dales sfaled:
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E�aeo��anraor�o
DNNECTED IF NOT COMPLETED WITh
2-���04
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her�by request inspection of the electrica� work at:
ttl-00001M14 8.1.2002