P - 77430� REQUEST FOR ELECTRICAL,l�NSP�.FCTION Q
1�� 5 7 3- 012 � Minnesota Board of Electricity �(��� Qa/ �ja
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us
❑ NEW ❑ REMO�L ❑ AD �TION PAIR DescR6e -using the back of the white copy 'rf necessary - the wak covered by this request:
to 800
ve 800
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparffius @$.50
ADDITIONS TO THE GENERAL F
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Additional Unit @ E25
OTHER ADDITIONAL FEES
Lighting Rehofit @ $.25 per Fizture
Center Pivot Irriaation Boom � $40
EREDI
I�I) II II� I) III II III II III II I�I II III () III �� I�
15730120
Outdow Liqhtina Standard
0
ONE & TWO fAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unii �a,l $80
( TOTAL FE; I �—� I
minimum total fee is $20
THISAREAFORIKSPECi0RU5E �
I hereby certify that I inspected the electrical installa6on described herein on the dales stated:
��s
OMPLETED WITHIN 12 MONTHS I
rcequest ate: � Rough-in Inspection Required? ❑ Yes A No Inspedion Other Than Rough-In: ❑Ready Now Will Call
�� You must call the inspector when ready! � Date Ready:
I ce ' that I am Uie LICENSED CONTRACTOR � COMPANY ❑ OWNER and hereby request inspection of the electrical work at::