P - 78263REQUEST FOR ELECTRICAL INSPECTION
1��� o— 8 6 6 5❑ Minnesota Board of Electriaty
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651)642-080011Y/MRS 1-800�27-3529 www.electricity.state
❑ NE � 0 REMODEL ❑ ADDITION EPAIR Describe -y, ing the back of ihe v�ljite copy 'rf necessary - the work covered b
800
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device w aratus $.50
ADDITIONS TO THE GENERAL F
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units @$50 Per Unit
Each Addition� Unit @ $25
OTHER ADDITIONAL FEES
htin Retrofit E.25 r Fixture
Center Pivot Irrioation Boom � S40
I THIS
I I� II �I II ��I II III II III II III II III II III ��I I��I
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� Trarisfortner I Power SuDdY fw Signs I Outline Liqhtinq .$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes ihe Service andlw Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
( TOTAL FE j I ����
minimum total fee is $20
THR AREA Fdi IfbPECipi USE OILY
I hereby certfy thffi I inspeckd the elec6ical inSfaNa6on destribed herein on tl�e dates stffied:
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Request Date: Rough�n Inspecfion Required7 ❑ Yes No Inspecfion Olher Than Raugh-In: ❑Ready Now I Call
You must call the inspector when ready! Date Ready:
I certify that I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and heieby request inspection of the electrical work at:
Job dress ( w Route No.) City Zip Code
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� License Number
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EB-00001M74 8.1.2002
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