P - 78029REQUEST FOR ELECTRIC�A�. INS� CTION
� 1- 5 2 3-118 � Minnesota Board of Electriaty I� (�g/ -
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
❑ NEW ❑ REMODEL ❑ ADDITJ(�N ❑ REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
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GENERAL FEES Outdoor Li htin Standard 51
SERVICES I POWER SUPPLIES TraRc Si9nal Standard (a� S5 ,/�r 1
ALARM,
CIRCUITS OF LESS THAN 50 VOLTS
ADDITIONS TO THE
MULTIFAMILY DWELLINGS PER UI
3 to 12 UniGs �$50 Per Unit
OTHER ADDITIONAL FEES
Retrofit O 8.25 cer Fixture
(IIII IIIII IIII) (IIII IIIII I��II IIIII IIIII �� I�
15231186
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
TOTAL FEE I �
(minimum total fee is $20) � ,
THIS AREA Fpi INSPECTOfi USE pSY
I hereby ceAify that I inspected the electrical insWlation described herein on Ne dates stated:
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Request D e: Rough-in Inspeclion Required? ❑ Yes Inspection Other Than 12augh-In: dy Now ❑ Will Call
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You must call the i�spector wh� ready! Date Ready:
I ceAify that I am the �ICENSED CONTRACTOR OCOA�ANY ❑ OWNER and hereby request inspection of the electrical work at:
INSiR11CTON! ON BACK OF YELLOW COPY BOARD OF ELECTRICRV CAPV EB-00001M14 8.1. 2002