P - 780261��53-961 a
NEW ❑ REMODEL ❑ A DITION ❑
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GENERALFEES
:RVICES / POWER SUPPLIES
ALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
3 to 12 Units �$50 Per Unit
Each Additional Unit @ S25
Retrofit � 5.25 Der Fixture
III� IIIII (IIII III�I IIIII (liil IIIII IIII� �� I�
15539612
REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electriaty
1821 University Avenue Suite S-128, Sai , Minnesota 55104
(651) 642-0800 TTY/MRS 1-800�27- � electricity.state.mn.us
� Desaibe -using the back of the white c ' - the work covered by this request:
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Traffic Si nal Standard S5
Su �lement� Fee E20
Transfortners u to 10 KVA $10
Transfonners over 10 KVA $ 20
Transfonner / Power Su for S' ns I Outline ' hti ES
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service anNw Power Supply up to 500 Ampwes, All
Cirouits and Two tnspection Trips Each Dwelling Unit �;80
Fee
iviw.rrx *— �
(minimum total fee is $20) i
TMSAREAFdiNSPECTORU5E0lLY
1 hereby cer6ty that I inspec0ed the dectrical ir�talWdon desxibed herein on the d�s staEed:
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OMPLETEO WITHIN 12 MONTHS
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G���- �� .S
Req e: Rough-in Irupection Required? ❑ Yes Inspedion Other Than Rough-In: y Now O VWI Call
i� O You musl call the inspector when ready! pete Ready. .
I ' that I am the �ICENSED CONTRACTOR ❑COA�PANY ❑ OWNER and hereby �equest inspection of the electrical work at: