P - 78032REQUEST FOR ELECTRICAL INSPECTION
�� 5 2 9���� � Minnesota Board of Electricity ..
1821 University Avenue Suite S-128, SainfPaul, Minnesota 55104
(651)642-080011Y/MRS1-800-&27-3529 www.electricity.state.mn.us
I NEW ❑ REMODEL � ADDITION �
/I/e �rJ / ocrJ�,'� "t0 f
GENERALFEES
EPAIR Describe -usi�g the back of the white copy'rf necessary - the work covered by this request
�sr ` f{� rT�h
Outdoor Lighting Standard @ $1
TraRc Si�n� Standard � 35
401 ta 800 Am re E50
Above 800 Am re a75
CIRCUITS I FEEDERS
� 0 to 200 Am e$5 � f� L
Above 200 Am e $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S tem Device or atus E•50
ADDITIONS TO THE GENERAL FEES
I Each Additional Unit @ 325 I
OTHER ADDITIONAL FEES
' htin Rehofit 3.25 Fixture
Center Pivot I' ation Boom E40
Manufactured Home Park Lots E2
Recreational Vehicle Paric Sites $5
arate Bondin Ins tion Sn1
S '� Ins 'on $30 r Hour
iallns 'on $.31 Mile
iIS INSTALLATION MAY BE ORDERED DISCON
IIIII IIIII IIIII IIIII IIIII i�Ill IIIII II III �� I�
15293822
ONE & TWO FAMILY DWELLING$ EACH UNIT
Includes ihe Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$60
TOTAL FEE I
(minimum total fee is $20) � D, .�O
TMIS AREA Fdt INSPECTOR 1bE Orlv
1 hereby cerfify that I inspected the electrical installation described herein on ihe dales staled:
zi""C�
C�(,��3 7
� ���
�Q.5Z7
Request Date: Rough-in Inspeclion Required? ❑ Yes No Irupedion Other Than Rough-In: y Now ❑ Wdl Call
�!— `l'�—Q 3 You must call the i�spector when ready! Date Ready: �-��
I cer�y that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the elecUical work at: