P - 78103� REQUEST FOR ELECTRICAL INSPECTION
Y��� I�-17 3 70 821 Unrversity Avenue 8u'd�e S- 28, Sair�t Paul, Mi nesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 . le ricity.state.mn.us
0 NEW ❑ REMODEL ❑ ADDITION REPAIR Describe -using Me bxk of ihe white copy ii nec work covered by Mis request:
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Above 200 Am e $70
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus E.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Additional Unit � 325
OTHER ADDITIONAL FEES
L' h6n Rehofit 5.25 r Fixture
Center Pivot I' ation Boom yW r► r
M�ufactured Home Park Lots n
Recreational Vehicle P�k Sites $5
arate Bondin Ins tion $20
Special Inspection � $30 cer Fbur
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15761737
Standard
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes ihe Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit � S60
TOTAL FEE I �
(minimum total fee is $20) ��
iH15ARE� FOR M6PECipi USE OIIY
I hereby cerUfy that I inspected the eleclrical installa6on dexribed herein on the dales sUBed:
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Rw�� �e: Roughin Inspecfion Required7 ❑ Yes �No Ins
� r� r O� pedion Other Than Rough-In. Ready Now ❑ VYII Call
You must call tlie inspecla when ready! Date Ready:
I ceAify that I am tlie �ICENSED CONTRACTOR ❑ COMPANY � OWNER and hereby request inspection of the electrical work at: