P - 75824REQUEST FOR ELECTRICAL INSPECTION
I 1— 9 3 4���� �,'? Minnesota Board of Electricity �- >
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 -
(651)642-OSOOTIY/MRS 1-500-627-3529 www.elecrizcity.st te.mn
De.scn'be -using the�b/ac�k of the �ite c�oJpy if neces�ry� - the w/o�rk covered by this requ�t: E' ���
�cavl/�3.�H/,Ii2�0 � Re�?Q/i7��!'4',�d'.o.e,o ��li�Te.L�a„d,o L� m .,_^_ `LP '
I SERVICES /
ALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A paratus @$.50
ADDffIONS TO THE GENERAL I
MULTIFAMILY DWELLINGS PER UN
3 to 12 Unils @$50 Per Unit
Each Addi�onal Un(t CaIl S25
'ALLATION MAY BE ORDERED
IIUI �III II� IIIII II� II�I IIIII IIIU �� (�
19341213
Transformers over 10 KVA $ 20
Transformer / Power Supply for S1gns / OuUine Li htin $5
ONE 81W0 FAMILY DWELLINGS, EACH UNR
Includas the Service and/or Power Suppty up to 500 Ampere.s, All
Circuifs and Two InspecGon Trips Each Dweliing Unit @$80
TOTALFEE
total fee is $20) �1�� �D
I hereby c�rd(y that I Uispected tlre electrh�l
herein on tha datea stated:
�re
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IF NOT COMPLETED WITHIN 12 MON'
FOR OFFiCE USE ONLY
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''"""' Rough-in Inspectlon ired7 ❑Yes No I
/ Requ nspection Other Than Rough-In: dy Now ❑ Wi0 Cell
����/� You must ceil the inspedor whan readyt Da6s R�dy. / 3��/i
I c�ertify that I am 1he �.ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER arM hereby request inspection of the eler�rical work at
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