P - 77638REQUEST FOR ELECTRICAL INSPECTIQN �r��'`Y`���
1�� 5�7°� O,4 7� Minnesota Board of Electricity ���.� ��� 6y �� �
�
1821 University Avenue Suite S-128, Saint Paul, Minnesota 551041 `'�5. -_�
(651)642-OSOOTTYIMRS 1-800-627-3529 www.electriciry.state.mn.us �a;' :
)escribe�using the back of the white copy if necessary� the work covgred by thjy�quest: , ,
d' �r��C %�l
GENERALFEES
SERVICES / POWER SUPPLIES
CIRCUITS I FEEDERS
0 to 200 Am ere $5
Above 200 Am ere $10
ALARM, COMMUNICATION, REMOTE CANTROL, SIG
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S tem Device or A paratus $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to.12 Units @$50 Per Unif
Center Pivot Irrigation Boom
Manufactured Home Park Lc
1 per Mile
I THIS INSTALLA
IIII IIIII II�II III�I I) III IIII) (I III IIIII �� I�
18510479
�
Fee�
�
over
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additional Inspection Trips @ $20
Investiqative Fee
iviiur�� �
total fee is $20) �
Mat I inspeded Ne elecVical installation descnbed herein on Ne dates stffied:
�---- �a-zk-�5
COMPLETED WITHIN 12 MONTHS____�
"a���j Rough-inlnspectionRequired? ❑Yes�No InspectionOtherThanRough-In�ReadyNow❑WiIlCall
%f% �� �OJ'
i��" You must call the inspector when ready! Date Ready:
I certify that I am the�ICENSED CONTRACTOR p COMPANY ❑ OWNER and hereby request inspection of the electrical work at