P - 79217� REQUEST FOR ELECTRICAL {NSPECTION
'��( V O-� 3 9 0 Minnesota Board of Electricity -
. 1621 University Avenue Suite S-128, Saint Paul, Minnesota 55704
(651) 642-0800 TT`l/MRS 1-800-627-3529 www.etectricity.state.mn.us
NEW O REMODEL 0 ADDITION ❑ REPAIR Descdbe -usin the back of the white copy if necessary - the work covered by this request:
�(CEL ENERGY SAVEf��s �vv�reH
GENERALFEES
0 to 200 Am ere $5
Above 2110 Ampere @$10
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCUITS, CIRCUITS OF IESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADQITIONS TO THE GENERAL F
MULTIfAMILY DWELIINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Liqhtina Rehofit na $.25 oer Fixture
Su demental Fee $20
Transformers u to 10 KVA a$10
Transformers over 70 KVA $ 20
Transformer / Power Su I for Si ns I OuUine Li h6n $5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and�or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each D�xelling Unit �$80
Fee
TOTAL FEE
(minimum total fee is $20) ?� ��'a
— rNis.nEnFOai�croause«ar
I hereby certiry Mat I inspected tl�e elec6ical installa6on described herein on tlie daOrs stated:
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Request Date: Roughan Inspec[ion Required? ❑ Yes Inspection Other Than Rough-In: ❑ eady Now ❑ Will Call
����� You must call the inspector when ready! Date Ready:
1 certify ihat I am tl�e CDtICENSED CONTRi4CTOR ❑COMPANY � OWNER and hereby request inspecdon of the elecUical work at::
INSTRUCTONB ON BACK OF VELLOW COPY BOARD OF ELECTRICRV COPY E&OOOOtA-74 e.t. 2002