P - 77584REQUEST FOR ELECTRIC� IN�P ��1��
1����- 9 8 9� Minnesota Board of Electriaty ��
1821 University Avenue Suite S-128, SaiM Paul, Minnesota 55
' (651) 642-0800 T'fY/MRS 1-800�27-3529 www.electricitysmte.mn.us
❑ NEW O REMODEL ❑ ADDITION EPAIR Describe -using the badc of the white copy 'rf �ecessary - the work covered by fha request
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or atus 3.50
ADDITIONS TO THE �ENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units @ E50 Per Unil
Each Additional Unit @ E25
OTHER ADDITIONAL FEES
Li htin Retrofit 3.25 er Fixture
Center Pivot Irti ation Boom j40
Manufactured Home Park Lots E25
Recxeational Vehicle Park Sites SS
Bondi Ins tion S20
Special Irapection � E30 oer Fbur
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16189896
Outdoor Lighting Standard
Trafic Sinn� Sfandard �
Includes ihe Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspec6on Trips Each Dwelling Unit � Z80
( TOTAL FEE I `� ��
minimum total fee is $20
T145 MEA FOR NbPECTOR USE pLY
I hereby c�r6(y tl� I inspec6ed the electrical i�taqa6on described haein an Ihe da�es stateE:
IF
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�i� �� Roughin Inspedion Required? LI Yes �No Inspedion Other Than RougMn.• �{teady Now 0 Will Ca�l
�- U You must call tl�e inspectar when readyl Date Ready. �� `
I cefiy that I am 1he LICENSED CONTRACTOR � COWIPANY ❑ OWNER and hereby request nspection � the electrical worlc at:
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