P - 78972REQUEST FOR ELECTRICAL INSPECTION
1-� 6 8 g�— g O 3 � Minnesota Board of Efectricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
� • j�� (65 1) 64 2- 0 8 0 0 T T Y/ M R S 1- 8 0 0- 6 2 7- 3 5 2 9 www.e lec trici ry.s ta t e. m n. u s
i
EW ❑ REMO ❑ ADDITION ❑ REPAIR Describe -using the back of ihe white copy d necessary - the work covered by ihis request.
ALARM, COMMUNICATION, REMOTE G�NTRO�,
CIRCUITS, CIRCUITS OF LESS THAN 5� VO�TS
Each System Device or Apparatus @ 5.50
ADDITIONS TO THE GENERAL F
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Additional Unil @ $25
OTHER ADDITIONAL FEES
Lighting Retrofit @ $.25 per Fixture
Center Pivot Irriaation 800m �$40 r'• .
Fee 9
up to 10
over 10 I
�NE & TWO FAMILY DWELUNGS, EAGH UNn
Includes the Service andlor Power Supply up to 5�� Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$8�
(minimum total fee is $20) � �
THIS AIiEA FOR INSPEC�OR USE CNLY
I hereby certify thffi I inspected the electrical insGllation described herein on the dates stated:
? - � c( , a l �' S`5_
:
I I�! il Ili Il ili il II{ If I�I II ill II 111 II Ifi ��{�
� �s19
16888034
�
�I
�a��� -b19s��
CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at: