P - 78065REQUEST FOR ELECTRICAL INSPECTION
1� J��O - 3 3 4� Minnesota Board of ElecUicity
1821 Universiry Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800�27-3529 www.electricity.state.mn.us
O NEW ❑ REMODEL ❑ ADDITION REPAIR Describe m the back of the white capy'rf necessary • the wak covered by this request:
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GENERAL FEES Outdoor L' hti Standard $1
SERVICES I POWER SUPPLIES TraRfic Sgnal Standard @ E5
)MMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS OF LESS THAN 50 VOLTS
MULTIFAMILY DWELLINGS PER
3 to 12 Units @$50 Per Unit
Each Additional Unit � $25
OTHER ADD
Li htin Retrofit $.25 r Fi�
Center Pivot Irri ation Boom
Manufactured Home Park Lots
Recreational Vehicle Park Site
al Inspection � S3� per Hour V �J
al Inspection � $.31 per Mile
ISTALLATION MAY BE ORDEI
IIIIIIIII IIIII IIIII IIIII I!Illnlll IIIII �� I�
15303340
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service ar�dlor Power Supply up to 500 Amperes, All
Grcuits and Two Inspection Tdps Each Dwelling Unit @$80
Reins tion Fee $2(1
TOTALFEE �
(minimum total fee is $20) �
THIS NtE� Fpi IlSPECipi USE OKY
I hereby ceNy tlwt I inspeckd the electrical insta@�on described herein on tlie dates staled:
IF
Req Rough-in Inspedion Required? ❑ Yes No Inspectbn OtF�er Th�
You must call the inspector when ready! Dale Ready: �
I certity that I am the CENSED CONTRACTOR OCOMPANY ❑ OWNER ard hereby
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