P - 75633REQUEST FOR ELE
� _ �� � 6 � � � Minnesota Board of Electr
1821 University Avenue Sliite
(651) 642-0800 TTY/MRS 1-E
� t�� i the�white�e�r.! e/��l i� /�i( 's r��yu�st:
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POWER SUPPLIES
ALARM, COMMUNICATION, REMOTE CONTROL
CIRCURS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Devic� or AuuaraWs Cla $.50
to
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Fee
Includes the Servi� andlor Power Supply up to 5� Am�r�, /N
Circufls and Two Inspection Trips Each Dwelling Unft �$80
Addtional InspecUon Trips @ $ZO
ImesdaaWe Fee
t (minimum total fee is $20) p�(,/o
nos u�n wa wsr�crors u� a�ar
)DffIONALFEES h'e� "' �7i'? °�
Fixtu�e I hereby cerdy that I 6�d fhe elecMml 4�stall�la� desaibed herein on
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21276894
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_D IF NOT COMPLETED WITHIN 12 MONTHS
RECD JI�N��'�`�°�007 �
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�� Rough-in Inspectlon Requlred? ❑ Y� �'Plo Inspedion Othe� Than Rough-In: 0 Ready Now �Q�ill Ceil
���0 s�� You muat call the inspector whsn readyl Date Ready:
I cerFiFy that I am tl�e CENSED CONTRACTOR ❑ COMPANY ❑ OWNER arM hereby r�uest insp�tion of the el�ricxl vuork at
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or
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Master Eledridan or P�
Ucar�se Number
wo (2) Phone Numbers I
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