P - 784911-46�6-156 �5
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ALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
to 12 Units @ $50
ach Additional Unit
Fixture
REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Sairrt Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800�27-3529 www.electricity.state.mn.us
� De,�ribe -using the back of ihe white copy 'rf necessary - the xrork covered by this request:
FEES
Fee
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Txro Inspection Trips Each Dwelling Unit �$80
Fee
( TOTAL FE; I � �q
minimum total fee is $20
THI$ PREA Fqt INSPECiqt USE OIIY
I hereby certify tlwt I inspected the elec6kal instaUa6on drsaibed i�rein un Ihe da�,t sta�ed:
I Ii�I �I III II III II �II �� III II I�I 11 �I ���� I�
14661565
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CONTRACTOR 0 COMPANY 0 OWNER and hereby request inspection of the electrical work at:
ovw�u yr tlt(; IRIGITY COPY
E&00001M74 BA.2002