P - 75524c� , REQUEST FOR ELECTRICAL INSPECTION � ��
L�� ��� 2 7 2� Minnesota Board of Electricity
�� �,� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
D 'be -using the the white wpy'rf necessary - the work covered by this request:
c� G���-r1 l� - - —1 ��
GENERAL FEES Outdoor Lightin StarMard @$1
SERVICES / POWER SUPPLIES Trafic Sisanal Standard Cal $5
ALARM, COMMUNICATION, REMOTE CANTROL, SIGI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device ar Ap a�atus @$.50
ADDRIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UN
3 to 12 Units @$50 Per Unit
Esch Addfional Unit @ $25
oni�aoomow� �Es
LI hting Retrofit $.25 per Fodure
CeMer Pivot Irrigetlon Boom $40
ManuFactured Home Park Lo� $25
Recrea�onal Vehicle Park Sftes $5
Se Bondin Ins 'on $20
Special Insc�ectlon Co� $30 oer Hour
Transtormsr / Power S for Si / Outline Li ' $5
`�NE & TWO FAMILY DIMELLINGS, EACH UNR
Includes the �rvice andlor Power Supply up to 5D0 Amperes, All
Circuits and Two Ir�sp�tlon Trips Each Dwellir�g Unit @$80
Add'�ional Ins 'on Tri $20
Inv�stigative Fee
Reins 'on Fee @ $20
TOTAL FEE ��+y ,
(minimum total fee is $20) C�
TNI$ ARE0. FOR NLPECfOR USE �.Y
I hereby certify that I Uispeded the ele�ical 6�tallatlon descaibed herehi on the dates s�ted:
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^� g pectlon Required? ❑ Y� No Inspedian Other Then Rough-In: ❑ Ready Now WN CaII
�'�, v 1 You must call the inspector when readyl Date Ready.
I certify that I am the �[LICENSED CONTRACTOR ❑ COMPANY � OWNER and herebp request inspection of the electrical work at
M9TRUCTIONB ON BACK OF YELLOW COPV
BOAR� OF ELECTRICITV COPV