P - 77140REQUEST FOR ELECTRICAL INSPECTION
�
� � � � � - 2 01 � Minnesota Board of Electricity �- �
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �"
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us � " '
�
Describg -usu �e back of the white copy if necessary - the work cover this request:
�u,r ��-n�'ic� '
0 to 400 Ar
401 to 800
Above 800
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or Ap aratus $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Add'Rional Unit (cD $25
spection @ $30 per Hour
spection @ $.31 per Mile
ALLATION MAY BE
! ���� �� ��� �� ��� �� ��� �� ��� �� (�� �� ��� �� ��� �� ��
1 9 2 1 2 0 1 8
�
Fee
�
over
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additional Ins ion Tri s $20
Investi ative Fee
Reins ion Fee $20
TOTAL FEE
(minimum total fee is $20) �� �
n{isu�nFOaiNSaECratuseanr -
I herebv certi(v that t inspeded ihe electrical installation desaibed herein on the dates stated:
�, -�-a�" I
DISCONNECTED_IF NOT COMPLETED WITHIN 12 MONTHS
-Ec�. : a,:��,
Date: /� /�� Raugh-in Inspection Required? ❑ Yes �o Inspection Other Than Rough-In: 0 Ready ill Call
I// � You must call the inspector when ready! Date Ready:
�
I certrfy that I am the_ CENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the elechical work at