P - 79119� REQUEST FOR ELECTRICAL INSPEC710N
1�� O O- 5 3 2 j J � Minnesota Board of Electriciiy -
(_� 182t University Avenue Suite S-128, Saint Paul, Minnesota 55104
/ „�'� ( (651) 642-0800 T1YlMRS 1-800-627-3529 www.electriciry.state.mn.ur
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❑ NEW EMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the wcork covered by this request:
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GENERAL FEES utdoor Liqhtinp Standard an. $1
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ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device a A ratus $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
Rehofit (d $.25 oer Fixture
Park
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17005323
Traffic Signal Standard
SuoPlemental Fee (a� $
0
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 5Q0 Amperes, All
CircuiGs and Two Inspection Trips Each Dwelling Unit @$80
70TAL FEE I ��
(minimum total fee is $20) /��
itu5 ARFA FOR INSPEGTOR USE
I hereby cerGfy thffi I inspected Me electrical installation described herein on the da0es staled:
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�eQ� �e� Rough-in Inspection Required? Yes Inspection Othw Than RougMn: �Ready Now Will Call
t'�,a ' b� You must call the inspeda when ready! Date R�dy:
I certiiy that i am the ICENSED CONTRACTOR ❑ CONIPANY ❑ OWNER and heieby request inspecdon of ihe etecUical work at: