P - 788231-42�-35� �
0
SERVICES I
Ki
GRCUITS / FEEDERS
0 to 200 Am ere b
Above 200 Ampere � 10
ALARM, COMMUNICATION, REMOTE CONTROI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Anoaratus � 5.50
to 12 Units � E50 Per UnR
ach Additional Unit � $25
Retrofit
REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800�27-3529 www.electricity.state.mn.us
R Describe -using the back of the white copy if necessary - the work covered by this request:
�E�tJ %�E�O%��
� i.31 per Mile �
'ION MAY BE ORDERED DIS�
I lIH ll l� II I I I I( III II II I II I I I II I II I I III II I� I�
14283584
Su emental Fee $20
Transformers u to 10 KVA $10
Transfortners over 10 KVA $ 20
Tr�sfortner / Power Su I for S' ns I Outline Li htin $5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
IpcludQS the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Tnps Each Dwelling Unit �$80
Addi6onal Ins tion Tri $20
♦ 1
Reins tion Fee $20
TOTALFEE
(minimum total fee is $20) � j7%
rHS uu� wa mSVECrort usE orar
I hereby cerOfy Ihat I inspetted Ihe dectrical insfalWmon described herein on Ihe d�es staBed:
ROlM11N DATE
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FHALNSPECiIOH -� �
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E%PIREDIR6VDpED TE
=CTED IF NOT COMPLETED WITHIN 12 MONTHS
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^w"� ""'c: Rough-in Inspectlon Required7 1�7'ir� ❑� ���� pm� �yn Rcwgh-In: ❑Ready Now Will Call
7Y
You must call the inspecta vrhen readyl pete R�dy;
I ce ' that I am tlie ❑ LICENSED CONTRACTOR ❑ COIuIPANY ❑ OWNER and hereby request inspection of tl�e electrical work at: