P - 77272r � � R�QUEST FOR ELECTRICAL INSPECTION
1"�7 �.4 � 7 2 4 I � I Minnesota Board of Electricity -
U 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651)642-080011Y/MRS 1-800-627-3529 www.electricity.state.mn.us
❑ NEW 0 REMODEL 0 AD TION 0 PAIR Describe -usiny ihe b k of the white copy if necessary - the work covered by this request:
to 800
ve 800
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aooaratus (a� $.50
Su lement� Fee 520
Transformers u to 10 KVA $10
Transformers over 10 KVA $ 20
Transformer / Power Su I for Si ns I OuUine Li htin $5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Txro Inspec6on Trips Each Dwelling Unit @$80
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE I �
3 to 12 Units @$50 Per Unit (minimum total fee is $20) (��1•�
E2Ch Addifi01121 Uflif �$25 rws ua� Foa uav�cr«e usE orar
1 hereby certily that I inspected the electrical insfall�on described herein on the dates stated:
OTHER ADDITIONAL FEES .ij „� n-^^ O� ��
Liahtina Retrofit � 5.25 cer Fixture �� '�
�
rpe Mile
MAY BE
II i Ill1 II I
Ilfl II��. ii �i� Il ltl ll ��� II III II (II II (II �� I�
1734724�:
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nequesc ua[e: Rough�n Inspection Required? LJ Yes U No Inspection Other Than Rough-In: jjJReady Now ❑ Will Call
/ ? ���(� � You must call the inspectw when ready! Date Ready: �\
E � ��%' C�
I certify that I am the �ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at::