P - 77265REQUEST FOR ELECTRICAL INSPECTION
1� 5 6 3���� � Minnesota Board of Electriaty
1821 University Avenue Suite S-128, Sairrt Paul, Minnesota 55104
(651) 642-0800 TiY/MRS 1-800�27-3529 www.electricity.state.mn.us
❑ NEW ¢REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy 'rf necessary - the work covered by lhis request:
►� 0 6 �-iti c�er�. i� ��%ci � l,� �T$ t N� l 7Li�A/
GENERAL FEES putdoor ' htin Standard S1
SERVICES / POWER SUPPLIES Trafic Si nal Standard $5
0 to 400 Amoere � E25 I� 7 c����„w�r� Foa � x�n
ALARM, COMMUNICATION, REMOTE CANTROL, SIGNALING
CIRCUITS, GRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or atus 3•50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unit
Each Additional Unit @ S25
OTHER ADDITIONAL FEES
Li htin Retrofit a•25 er Fixture
Center Rvot Irti �on Baom yW
Manufactured Home Park Lols S25
Reaeational Vehicle Park Sites $5
arate Bondi Ins tion S20
' Ins 'on S30 r Fbur
S ial Ins 'on $.31 r Mile
THIS INSTALLATION MAY BE ORDERED DI
I IIII II III ii l ll II ill II III II III il lli II III N� I�
15632573
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service aridlor Power Supply up to 500 Amperes, All
Grcuils and Two Inspection Trips Exh Dwelling Unit @ S80
TOTALFEE �-7 �-T
(minimum total fee is $20) <� J v
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I hereby cerYry tl�at I i�petled tlie dxtrital i�taY�on destribed I�rein on tl�e da0e5 sGled:
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�V Rough�n I�spection Required? ❑ Yes ❑ No Inspedion Otlier Than Rough-In: ❑Ready Now O WiH Call
�0 6r_ You must call the inspector when ready! Date Ready:
I ce�ti(y tliat I am the ❑ UCENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request mspection of the electrical work at:
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