P - 79019REQUEST FOR ELECTRICAL INSPECTION �
1= ��'� •a g 9 4 � Minnesota Board of Electricity �
1821 University Avenue Suite S-128, Saint Paul, Minne �
(651) 642-0800 TTY/MRS 1-800-627-3529 www ec ' t.mn.us
❑ NEW ❑ REMODEL O ADDITION REP Describe s' g the back of the white cop 'rf necessary - the wo ered by this request:
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GENERAL FEES Outdoor Lighting tandard_@
ALARM, COMMUNICATION, REMOTE CONTROI
CIRCUITS, CIRCUITS OF LESS THAN SD VOLTS
Each System Device or Apparatus �$.50
ADDITIONS TO THE GENERAL
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units @$50 Per Unit
Each Addi6onal Unit @ $25
Fixture
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes ihe Service andlor Power Supply up to 500 Amperes, Alt
Cirouits and Two Inspection Tnps Each Dwelling Unit �1 S80
e.f,Gf�nn�l �ncnerfin� Trinc Gl 4�n •
Reins tion Fee $20
TOTALFEE
(minimum total fee is $20) � •��
T IXS MEA Fd31N5PECTOR USE qlY
I hereby ceAify that I inspected the electrical insfallation described herein on the d� st�ed:
S iallns 'on E.31 Mi�
THIS INSTALLATION MAY 8E ORDERED DISCONNECT
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Req Roughtin Inspactian Required? ❑ Yes Inspedion Other Th� M. Now Q WNI Cell
You m�t call tl�e inspectw when readyl pete R�dy,
I certify lhat I am tlie UCENSED CONTRACTOR ❑ COMPANY ❑ OWNER and iispection of the electrical work at:
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