P - 78025REQUEST FOR ELECTRICAL INSPECTION
.�,�� 0 g_� 8 9 � Minnesota Board of Electriaty
1821 University Avenue Suite S-128, SaiM Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800�27-3529 www.electricity.state.mn.us
�jJEW ❑ REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of ihe white copy if necessary - the work covered by ihis request:
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GENERAL ES Out or Li htin Standard $1
SERVICES / POWER SUPPLIES Traific Sional Standard [d S5
401 to 800
AIARM, COMMUNICATION, REMOTE C(
CIRCUITS, CIRCUITS OF LESS THAN 50
Each System Device or Apparatus @
ADDITIONS TO THE GE
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units @$50 Per Unit
OTHER ADDITIONAL FEES
a� $.25 oer Fixture
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 @ L80
, � TOTAL FEE I
��'~ mimr�um total fee is $20) 3�' •��
THIS AREA Fqt INSPECTIXi USE qSY
I hereby certify that I inspected the elec9ical insfalla6on descnbed haein on the dates sfated:
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Request Dffie: Rough-in Inspection Required7 ❑ Yes InspeUion Other Than Rough-In: dy Now ❑ Nfill Call
, a_ j,� ��� You must call the inspector when readyl Date Ready:
I certiTy that I am the �ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the elecUical work at: