P - 79305� ❑ REQUEST FOR ELECTRICAL INSPECTION
�� 1��- 5 6 5 J Minnesota Board of Electriciry -
1821 University Avenue Suite S-128, Saint Paui, Minnesota 55104
� (651)642-0800TlYlMRS1-S00-627-3529 www.etectricity.state.mn.us
t! NEW ❑ REMODEL ❑ ADDITION O REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
KCEI. EPIERGY �A'dER'S S�AJITCH
GENERAL FEES Outdoor Liahtina Standard (a� $1
4�1 to 800
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALiNG
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A aratus $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
to
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$80
TOTAL FEE I
(minimum total fee is $20) $2a.50
iH15 ARFA Fqi INSPECTpi USE ONLY
l hereby cer6ty tliat 1 inspec�d Me electrical instaNaOat described herein on the date5 staled:
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I Request Date: Rough-in Inspection Required? ❑ Yes 0'No {rupection Other Than Rough-In: Dl�ady Nav O WiIV CaN
(j���j You must call the inspedor when ready! Date Ready:
I certiry U�at I am the �tCENSED CONTRAGTOR ❑ GOMPANY 0 OWNER and hereby reque�st inspection of tlie electrical work at::
IN$TRUCTONS ON BAGK OF YELLOW COPY BOMD OF ELECTRICITV COPY E&00001M14 8.1. T002