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:
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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
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1506254D
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� 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:
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"°`�"`�` "° • 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: