P - 78017REQUEST FOR ELECTRICAL INSPECTION
.� - 5 6 3��� 0 � Minnesota Board of Electricity
G� 1821 University Avenue Suite S-128, SaiM Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us
W❑ REMODEL ❑ ADDITIO ❑ REPAIR Describe -using the back of th white copy 'rf necessary - the work covered by this request:
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GENERAL FEES Outdoor L' hfin St�dard E1
SERVICES / POWER SUPPLIES Traflic Si n� Standard $5
0 to 400 Am re E25 Su mental Fee 320
401 to 800 Amcere CaD $50 Transformers up to 10 KVA �1 S10
0 to 200 Am re E5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am $10 Includes ihe Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins tion Tri $20
Each S stem Device or alus S•50 investi a6ve Fee
ADDITIONS TO THE GENERAL FEES Reinscection Fee �$20
fIFAMILY DWELLINGS (PER UNIT) ' TOTAL FEE I
3 to 12 Units � S50 P� Und (minimum total fee is $20) �s, s�
E2Ch Addi6 W121 U�il �$25 TH�s u��, Fa+xsa�croa usE aa r
I haeby certi(y Ih� I inspected the electrical insfalla6on desaibed herein on Me da�es sta�d:
OTHER ADDITIONAL FEES � � � � -r'o ,j - S�� 7`` ` / ~�
tpecial Inspection @ 5.31 per Mile
i INSTALLATION MAY I
IIII IIIII (III) II�II IIIII II III IIIII (III) �� I�
15637309
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Request Date: Roughin Inspection Required? LJ Yes �No Inspedion Other Than Rough-In: LJReady Now}�d'Will Call
� a a_� You must call tlie inspecta when ready! Date Ready: >
I certify that I am the �IC�ENSED CONTRACTOR 0 COMPANY ❑ OWNER and hereby request inspection of the electrical work at: