P - 78000REQUEST FOR ELECTRICAL INSPECTION
1����- 0 6 5� Minnesota Board of Electriaty
1821 University Avenue Suite S-128, Sairrt Paul, Minnesota 55104
(651) 642-0800 T7Y/MRS 1-800�27-3529 www.electriciry.state.mn.us
❑ NEW REMODEL ❑ ADDITIO 0 REPAIR Desaibe -using the back of the whHe copy rf necessary - the work covered by this request:
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GENERAL FEES Outdoor Li htin Standattl 37
SERVICES / POWER SUPPLIES �/1 Tralfic Sgnal Sfandard � ES �__) �
AL4RM, COMMUNICATION, REMOTE CONTROI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units @ 550 Per Unit
Each Addi6onal Unit @ $25 �
Retrofit 0 5.25 cer Fixture
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L5290653
ONE 8 TWO FAMILY DWELLINGS, EACH UNR
Includes ihe Service andlor Power Supply up to 500 Amperes, All
Grcuits and Two Inspec6on Trips Each Dwelling Unit @ S�
Inves' ativeFee
Reins ' n Fee E20
TOT/LL FEE �
(minimum total fee is $20) �
TWS MEA Fdi IISPECTOR USE CfLY
I hereby cer6Ry Mat I inspecled the i �herein on dates sqBed:
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Raq Date: Rough-in InSpecUon Required? LJ Yes No Inspe�iion Other Than Rough-In: ❑Ready Now VYYII Call
� aS o N You must call the inspecta when readyl pa(e Ready:
I rti(y tha am the �UCENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request nspection of ttie electrical work at: