P - 75627REQUEST FOR ELECTRICAL INSPECTION
1� 7 4 7��� � Minnesota Board of Electn}dtyt ,
21 University Avenue Suite S-128, Saint Paul, Minrtesota 55104
f�� 881) 642�800 TTY/MRS 1-8Q0-627-3529 www.elecbiciry.state.mn.us
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0 NE4N � OD� O ADD ON 0 REPAIR Desaibe -using the badc of tl�e�py if n�yr - the xro ered by Uds re�{uest
!I! i'Y � +
GENERAL FEES Outdoor ' ' Slandard $1
SERVICES / POWER SUPPUES ._ Traff�c Signal Sfandard @ $5 /' � __ .�,
ALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
F�ch SYstem Da�ice ar MPerelus C�3 $.50
ADDffIONS TO THE GENERAL I
MULTIFNWLY DWELLINGS PER UNI
3 to 12 Units @$50 P� Unit
F�:h Addidonal Unit @ $25
OTHER ADDITIONAL FEEE
Liahtiim Retrofit l�a $.25 oer Fudure
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ONE 8TW0 FAMILY DWEWNGS, EAGH UNIT
Includes the Service andlm Poarer Supply up to 500 Amperes, All
Circuiffi and Two Inspection Trips Each Dweliing Unit @$E
(minimum total fee is $20) �
nas a�a wa uavECTat u� a�ar
I hereby cer�y tl�at I I�d tt� n descWed I�rein on tlre dat� st�d:
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�-e�e7,��--t Date:p Rough�n I�pection Required? as ❑ No I Uspedion Other Than Rwrgh-In: �Ready Now Qi�4Q�CaII I
Y' �b J C!/l �� You must cell the ins� wh� readyl Date Ready. .
I c e r ti f y i h a t I a m 9 re ❑ U C E N S E D C O N T R A C T O R � C O M P A N Y ❑ OWNER and hereb y � q uest ms p� On of the elechu:al work at: