P - 77020F REQUEST FOR ELECTRICA4,INSPECTION �
1 � 913 � � H � � Minnesota Board of Electricity ..��� /�� �� �-; / �
� 1821 University Avenue Suite S-128, Saint�Pa�f,1CIi�5esot�551Q4 �, 'i
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
Descnbe -using the badc of the white copy if necessary - the work covered by this request:
s �i� /►�te 1c �ST �.-�, �
GENERAL FEES Outdoor L' tina Standard (�D $1
0 to 400 Ar
401 to 800
Above 800
;UITS I FEE
0 to 200 Ar
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Ap aratus $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Additional UnR @ $25
Retrofit (�D $25 cer Fixture
Hour
Mile
Standard
Fee $.
up to 10 I
over 10 N
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Add'Rional Ins ection Tri s $20
Investi ative Fee
Reins ion Fee $20
TOTALFEE
(minimum total fee is $20) 3�� S�
THIS AREA FOf11N5PECTOR USE ONLY
I herebvi cerlifv that I inspeded the electrical installatian desaibed herein on ihe dates stated:
�
NECTED IF NOT COMPLETED WITHIN 12 MONTHS
�� x. : ! ��...
� ���� �� ��� �� ��� �) ��� �� ��� �� �� �� ��� �� ��� ��� ��
19131812
uaie: Rough-in Inspection Required? ❑ Yes �No Inspedion Other Than Rough-In: ❑ Ready Now ❑ Will Call
�/� � You must calf the inspedor when ready! Date Ready: ��0�� �
I certify that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at