P - 78215� REQUEST FOR ELECTRICAL INSPECTION �
1� 4 6 6� V J O � Minnesota Board of Eiectricity
1821 University Avenue Suite S-128, Saint Pa�d, Minnesota 55104
(651) 642-OB00 llY/MRS 1-80D-627-3529 www.electricity.state.mn.us
�DDITION O REPAIR Describe -using lhe back of the white copy if necessary - the work covered by this request:
RS�»�G� �{"
ALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL I
MULTIFAMILY DWELLINGS (PER UNIT)
3 to 12 Units @$50 Per Unit
Exh Additional Unit @ $25
OTHER ADDITIONAL FEES
Li h6n Retrofit 5.25 er Fixture
Center Pivot Irri ation Boom @$40
M�ufaclured Home Park Lols a25
Recreational Vehicle Park Sites $5
arate Bondin Ins tion $20
Special Inspection � $30 per Hour
I IIII �III II III II Iil II III II III II III II III I� i�
14666507
Su lemental Fee S20
Transformers u to 10 KVA $10
Tr�s(ortners over 10 KVA �$ 20
Transfortner I Power Su I for Si ns I OuGine Li htin $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes ihe Senice andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Addiliona� Inspection Trips @ $20
Investiaative Fee
TOTAL FEE �C
(minimum total fee is $2(1) a .. .�
iH15 MEA Fpi INSPECTpi USE ONLY
I hereby certify tlwt I inspecOed the electrical insfallaAon descnbed herein on the dates sfated:
I�3/—�3
12
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C�'� � �0 � 5�
etequest uate: Rough�n Inspection Required? �Yes L1 No Inspedion Other Than Rough-In: UReady Naw�ll Call
1;1 % �61 D,�j You must call the inspeda when ready! oso� a�eY
I certify that I am the �ICENSED CONTRACTOR ❑ COA�ANY ❑ OWNER and he�eby request c�spection of Ihe electrical work at: