P - 77280---- REQUEST FOR ELECTRICAL INSPECTION
��� 1�-14 5� Minnesota Board pf ElecViciiy
1821 University Avenue Suite S-128, Sairrt Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800�27-3529 www.electricity.stafe.mn.us
0 NEW ❑ REMODEL ❑ ADDITION REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
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GENERAL
/ICES I POWER
0 to 400 Amcere
0 to 200 Am re $5
Above 200 Am re $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or ratus $.50
ADDITIONS TO THE GENERAL FEES
Z Units � $50 Per Unit
Additional Unit � S25
25 per Fi�Aure
i Boom @ ¢W
Park Lots E
Park Sites � ;
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L5761455
Outdoor
10KVA(a�$10
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Grcuits and Two Inspection Trips Exh Dwelling Unit @ S80
Additional Inspection Trips �D $20
InvesGgative Fee
Reinsoection Fce Ca1 S20
J �
(minimum total fee is $20) —
TH6 ARFA FOR IILSPECTqi USE p1Y
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��e: Raugh-in Inspection Required? ❑ Yes �,(Jo Inspedion Other Than Ragh-In: ❑Ready Now Wfll Call
rZ ���� You must call the inspector when readyl Date Ready:
I cefiy Uiat I am the ICENSED CONTRACTOR ❑ COA�ANY ❑ OVIMER and hereby request inspection of the electrical work at: