P - 78852/1 REQUEST FOR ELECTRICAL INSPECTION
1� 4, o°� —,-�i, O 2 � Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800�27-3529 www_,��leC(ricity.state.mn.us
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❑ REMODEL ❑ ADDITION ❑ REPAIR Describe -usir� the back oj�e v�rte�ry n nec:e� a� �� w� c�.���� �r ����� ��ti���:
GENERAL
ALARM, COMMUNICATION, REMOTE CONIRUL
GRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
12 Units � S50 Per
i Additional Unit � ;
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, NI
Circuits and Two Inspection Trips Each Dwellirg Unit �$80
( TOTAL FEE I�/'/ / C U
minimum tohal fee is $ZO �� �
TH5 AitEA Fqi MbPECTdi USE OKY
I hereby cerYfy tl�ffi I inspecBed tlie electrica� ir�alWOOn described herein on the da�es slaled:
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and hereby request inspection of the electrical wak at: