P - 786171- 4� 8' � 7 0 � REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
i� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
�� �„ y� (651) 642-0800 TTY/MRS 1-800�27-3529 www.electricity.state.n�n.us
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❑ NEW EMO ❑ ADDITION REPAIR Dp�cribe -using the back of the white copy if necessary - the work covered by this request:
tM, COMMUNICATION, REMOTE CONTROL, SIGNALING
:UITS; CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL FEES
TIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unit
Each Additional UnR Q $25
���I II I�� II II� II „I II III �I � II ����� I�
14088702
Traffic Signal Standard
Suuolemental Fee Co� S
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuils and Two Inspecdon Trips Exh Dwelling UnR � 380
AddiGonal Inspection Trips � $20
Investiaative Fee
(minimum totai fee is $20) � pt(�?�'
THS NiEA Fpi IILSPECTqi USE OItY
I hereby cer6y Mat I inspecBed Ihe electrical inslaAa6on desaibed haein on Cie daAes sfated:
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�Q�� �e� Rough-in InspeGion Required7� Inspedion Olher Than RaugMn: dy Now � WAI Call
��� You must wll the inspector when rea pate Ready:
I certify ihat I am the ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of U�e elechical work at:
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EB-OOOOtA-14 8.7.200i