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P - 78078�— REQUEST FOR ELECTRICAL INSPECTION .1- 5�� 6- 2 5 4� Minnesota Board of Electriaty 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 (651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us O NEW ❑ REMOD ❑ ADD ION ❑ REPAIR Describe -usin the bxk ot the white copy'rf necessary - the work covered by this request: � c� �v��Q � GENERAL FEES Outdoor Li htin Standard E1 SERVICES / POWER SUPPLIES Traflic Sianal Standard � 85 ALARM, COMMUNiCATION, REMOTE CONTROL CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Each System Device or Apparatus E.50 ADDITIONS TO THE GENERAL I MULTIFAMILY DWELLINGS (PER UNIT) 3 to 12 Units �$50 Per Unit Each Additional Unit @ $25 OTHER ADDITIONAL FEES Li h6n Retrofit $.25 er Fixture Center Pivot Irri ation Boom E40 Manufactured Home Park LoLc Ez5 Recreational Vehicle Park Sites t5 arate Bondin Ins Gon $20 Special Inspection � $30 per Hour IIII IIIII IIIII II�I �I� �III IIIII IIIII �� I� 1506254D 0 � Transformer / Power SuDDIy for Siqns I Outline Lightinq ES ONE & TWO FAMILY DWELLINGS, EACH UNIT Includes ihe Service andlor Power Supply up to 500 Amperes, All CircuiLs and Two Inspection Trips Each Dwelling Unit @$60 (minimum total fee is $20) � Gl'v� rH�s u�, Foa iruaECTan usE aar I hereby cer6y Mat I inspected the electrical installaAOn described huein on the dates stated: Pa�l- i� g ... .•3 ��Z—^ c'�i 5��� � �o. s � "°`�"`�` "° • Rough-in Inspection Required? ❑ Yes Inspection Other Than 12ough-In: dy Now 0 Will Call �� / You must call Ne inspector when ready! �ate Ready: I certify that I am tlie ❑ LICENSED CONTRACTOR 0 CON�ANY ❑ OWNER and hereby request inspection of Ihe e�ctri�� work ax: