P - 787041- 4 O�-� O O � REQUEST FOR ELEC� RICAL INSPECTION
Minnesota Board of Electrici
� �_� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651)642-0800 TTY/MRS 1-800�27-3529 www.electricity.state.mn.us
❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR Describe -us�in'�'e back of wh�i '`°� necessary - the work covered by this request:
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SERVICES I POWER SUPPLIES
0 to 400 Ampere . $25
� 401 to 600 Ampere $50
� Above 800 Amcere O 875 �
CIRCUITS I FEEDERS
Z 0 to 200 Am re @$5 —�
Above 200 Amcere �510
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALII
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or aratus $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL FEES
Li htin Retrofit $25 er FiMure
Center Pivot Irti ation Boom y40
Manufaclured Home Park Lots a25
Recreation� Vehicle Park Sites $5
Se arate Bondin Ins tion $20
S iallns 'on y30 Hour
S 'allns 'on $.31 Mile
THIS INSTALLATION MAY BE ORDERED I
I IIII II Ili il Iil II III II III �I III II �II II III a III I I�N
14088009
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service anNor Power Supply up to 500 Amperes, All
Circuits and Txro Inspection Trips Each Dwelling Unit @$80
Reins fion Fee $20
TOTALFEE
(minimum total fee is $20) �D '�
TIMS MFA Fpi MSPECTq2lI5E OIIY
I hereby ceNfy that I inspected Ihe dectrical insiallatian �Cribed herein on the da0es sta�d:
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Reques� uace: Rough-in Inspection RequiredT ❑ Yes No InspeGion Other Than Rough-Irc ady Now � Will Call
y�� 9�0 -� You must call the inspecta when ready! Date Ready.
I certify that I am ihe '� UCENSED CONTRACTOR ❑COMPANY ❑ OWNER and her�by request inspection of �e electrical xrork at::