P - 79139REQUEST FOR ELECTRICAL INSPECTION
1�� C: �- 4 5 8 2❑ Minnesota Board of Electricity -
� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
•' (651) 642-0800 TTYlMRS 1-800�27-3529 www.electricity.state.mn.us
NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
0 to 400 Am ere $25
401 to 600 Ampere @ $50
Above 800 Ampere @ $75
CIRCUITS / FEEDERS
0 to 200 Ampere @ $5
Above 200 Ampere @$10
ALARM, COMMUNICATION, REMOTE CONTROI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aooaratus � 5.50
Outdoor Lighting Stand
Traffic Sianal Standard
ONE 6 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspeclion Trips Exh Dwelling Unit @$BO
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE I 46 .
3 to 12 Units @$50 Per Unit (minimum tot21 fee is $20)
EeCh Addi60n21 U�it �$25 rHa uu� F«e irsaecraa usE aar
I hereby certify that I inspec�ed the electrical i�falla6on deuribed herein on the da6es sta�ed:
OTHER ADDITIONAL FEES
Lighting Rehofit � $.25 per Fixture � O � � � (� � � � O
lill II�I II�I I�III II�!! IIIII �ill II�i �� I�i
1 7 2 5 4 5 8 2
� �6599
� , �,- o�
� ��
� �l .
�.ayue,,� va�e. F�gh-in Inspecfion Requirad? ❑SYes ❑ No I Ir�spec�on Other Than Rough-In: ❑Ready Now Wf�l II Call --
12-8-04 You must call the inspedor wh� reedy! pe� �y;
I ceAify that I am the �LICENSED CONTRACTOR ❑COIu�ANY ❑ OVIMER and hereby �quest mspection of the elecbiral work at:
-�• � � �• �•.•••••••••••• � w• • CCYMNI/Fl9 O.l. NIlL