P - 78697r (� REQUEST FOR ELECTRICAL INSPECTION
�� - 4 3 � � � �J �J � Minnesota Board of ElecVicity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us
O NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR Describe -using th�e bj� k of the white copy if necessary - the xrork covered by this request:
✓�' � �/i�G�9 � GL7
GENERAL FEES Outdoor Li hfin Standard $1
SERVICES 1 POWER SUPPLIES Traffic Si nal Standard $5
0 to 400 Am re $25 Su lemental Fee $20
401 to 800 Am re$50 Transfortners u to 10 KVA $10
nr,�,,,a ann am�.a n x�� Transformers over 10 KVA (� $ 20 _
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALIN�
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Apparatus �$.50
fIFAMILY DWELLINGS (PE
3 to 12 Units @$50 Per Unit
Each Additional Unit � $25
Boom
��I �I II� �! II� �� III II III �I (II II III I� (II ���I I I�
14388565
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Ci�cuits and Txro Inspection Trips Each Dwelling Unit @$BO
(minimum total fee is $20) � ,��� J
TMSRREAFORIl6PECTp2U5E0NLV
I hereby ceAify Nat I inspected the electrical insWla6on described herein on the dates staled:
1
G�
�.}ral`�S
�DSo
Requ t e: Rough-in Inspection Required? ❑ Yes ❑ No Inspection Other Than RougMn: �Ready Now II Call
�� �•� You must wll the inspector wh� ready! Date Ready:
I certiTy that � am ihe �ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at: