P - 78610�_ n��° O�� � REQUEST FOR ELEC� RICAL INSPECTION
�-f ❑ Minnesota Board of Electrici _
1821 University Avenue Suite S-128, SaiM Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800�27-3529 www,electricity.state.mn.us
❑ NEW ❑ REMODEL ❑ ADDITION REPAIR De3cribe -u�he back of the white copy 'rf necessary - the work cove2d by this 2quest: ^�
� i1�t_A - - -
ALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
_ Each System Device or Aooaratus (� 5.50
Units � $50
Transformers u to 10 KVA $70
Transformers over 10 KVA $ 20
Transformer I Power Su i for Si ns / OuUine Li hGn $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Inciudes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspec6on Trips Each Dwelling Unit �$80
AddiGonal Ins ection Tri s�$20
Inves6gative Fee
( TOTALFE; I �D'�
minimum total fee is $20
THIS �REA FOR INSPECTOR USE pLY
I bereby cerGy that I inspected the electrical install�on despibed I�aein on the da�s s�ed:
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I certify that I am the
Raigh-in Inspection Required? ❑ Yes i�f Npi I Inspection C
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You must wll the inspector when ready! l Date Ready,
NSED CONTRACTOR ❑COMPANY ❑ OWNER a�
Now � Nlill Call
inspection of the electrical xrork at: