P - 77277REQUEST FOR ELECTRICAL INSPECTION
1� 6 7 6� J 0� � Minnesota Boar�j of Electricity
1821 Un�versity Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-08Q0 TTY/MRS 7-800-627-3529 www.electricity.s[ate.mn.us
❑ N W% REMODEL O ADDITI ❑ REPAIR Desc '-using the back the white copy if necessary - the work covered by this request:
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GENERAL FEES Outdoor Li htin Standard E1
SERVICES / POWER SUPPLIES Trafic S� nal Standard a5
1 0 to 400 Amcere Ca1$25 n._ i M cunn�rr�n�ai Fon n e�n
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or ratus 5.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Li hGn Retrofit $.25 er Fixture
Center Pivot im ation Boom $40
M�ufactured Home Park Lols $25
Recreational Vehicle Park Sites �185
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dweliing Unit @$80
( TOTAL FE; I � r�
minimum total fee is $20 J�'�
T«is u�n Foa maaECTaa usE aar
I hereby ceAify that I inspected the ekc6ical installa6on described herein on the dates sfated:
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rcequest uate: Rough�n InspecGon Required? ❑ Yes �l No Inspection Othenr Than Ragh-In: Ready Now ❑ Wfll Call
�3 �S You must call the inspector when ready! �\ Date Ready: ,.,/ .�.��
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I certify that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of ihe electrical work at: