P - 77428REQUEST FOR ELECTRIC INSPECTION
1� J��- 011 � Minnesota Board of Electricity �OC7�-�� 1(� 5'
1821 University Avenue Suite S-128, SaiM Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
❑ NEW ❑ RE �E� ❑ ADDITION �PAIR Desc�6e -using the back of the white copy ff necessary - the work covered by this request:
SERVICES I POWER SUPPLIES
0 to 400 Am re $25 +
401 to 800 Am re $50
Above 800 Am re E75
CIRCUITS / FEEDERS
0 to 200 Am re $5
Above 200 Am re $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or aratus $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Li htin Rehofit $.25 er Fi�Aure
Center Pivot Irri ation Boom $40
Manufactured Home Park Lots $25
Recrea6onal Vehicle Park Sites $5
Se arate Bondin Ins tion $20
S ial Ins 6on $30 er Hour
S ial Ins ion $.31 r Mile
THIS INSTALLATION MAY BE ORDERED DI
I IIII II (II �I �II II II� II III II III II III II III �bI I A�
1 5 7 3 � 1 1 2
Outdoor Ligh6ng Standard
Tratfic Sianal Standard �
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
( TOTAL FE j I ��
minimum total fee is $20
THISAREAFIXtINSPECi0RU5 r
I hereby cer6y mat I inspected the elec6ical installa6on described herein on the dates sfated:
� ``--� `," Z � -� %
DAiE
VITHIN 12 MONTHS
Re9ue� a�e: Rough-in Inspection Required? ❑ Yes �'No Inspettion Other Than Rough-In: ❑Ready Now V1rlf Call
�j 0 You must call the inspector when ready! Date Ready:
I cerhty tl�at I am the ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at::