P - 77429REQUEST FOR ELECTRIC L INSPECTION
1� J��� U o 6 � Minnesota Board of Electricity ��S .�a( �/
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 551 d4
(651) 642-0800 TTY/MRS 1-800�627-3529 www.electricity.state.mn.us
❑ NEW REMODEL f�ADDITION� 0 REP� Describe,�using the back of the white copy 'rf necessary • the wak covered by this request:
i�.'�iC.^u
uKt;ui i 5 i rttutKS Transformer I Power Su I for Si ns I Outline Li htin $5
0 to 200 Am re $5 ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Above Z00 Am re $10 Includes tl�e Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspec6on Trips Each Dwelling Unit @$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additian� Ins tion Tri s $20
Each S stem Device or aratus $.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins tion Fee $20
MULTIFAMILY DWELLINGS PER UNIT TOTAL FEE
3 to 12 Units @$50 Per Unit (minimum total fee is $20) j%
E2Ch Addi60�21 U�If �$25 TH�s n�,� Fa+ir�svECr«e use aar
1 hereby cerAfy that I inspected Me ekttric� insqllation described herein on the dates stated:
OTHER ADDITIONAL FEES
h6n Retrofit $.25 r Fixture
Center Pivot Irti ation Boom $40 p0U°"" �TE
Manufactured Hortie Park Lots $25
Recreational Vehicle Park Sites � 85 Firu� r+s�crwr� j a,TE
4-`-- % �ZG^�
Hour
IIII IIIII IIIII III�1 IIII) IIIII IIIII II�II �� I�I
15730062
�� �e: h-in Inspection Required? ❑ Yes � No Inspedion OIAer Than Rough-In: dy Now O Will Call
� Q You must call the inspeda when ready! pete Rp,edy:
I oertify that I m the fd'�ICENSED CONTRACTOR � COIuIPANY ❑ OWNER and hereby request inspection of the electrical work ah:
Job Site Address (Street aox. p�L � q ��--
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m�cer oecv�cian a
Ucense Number
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