P - 784101-499-963 ❑5
❑ NEW ❑ REMODEL ❑ ADDITION
t.�,�.(� _ � ��q5�- i�
SERVICES I POWER :
0 to 400 Am re Q
401 to 800 Am r
Above 800 Am r
CIRCUITS I FEEDERS
1 0 to 200 Amcere �
REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTYIMRS 1-800-627-3529 www.electricity.state.mn.us
REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
AIARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
MULTIFAMILY DWELLING�PEI
3 to 12 Units @$50 Per Unit
Each Additional Unii @ $25
(IIII IIII) IIIII IIIII (IIII IIIII IIIII I�III �I�� I�
14999635
�
Standard
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$60
ivia�rtt S-O
(minimum total fee is $20) �� --
THIS MEA FOR INSPECTOR USE ONLV
I hereby cerfiy Nat I inspected the electrical instaNaGon described her�n on the da�s stNed:
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�Q� Roughin Inspection Required7 ❑ Yes Inspedion Other Than Rough-In: ady Now ❑ VYAI Call
� 1 b You must call the inspector when ready! Date Ready:
I certify that I am the �LICENSED CONTRACTOR OCOMPANY ❑ OWNER and hereby request nspection of the electrical work at: