P - 77133REQUEST FOR ELECTRI AL INSPEC 10
1� 6 3 7- 3 6 8� g�2� Unrv rs� Ave � e Suite S- 28, Saint Pau� inb j�O �G�
(651) 8 TlY/MRS 1-800-627-3529 www.electricity.state.mn.us
❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR - ing the ba�k of the while copy if necessary - the work cove2d by this request:
c..l.% � vut,u� 3 Y'P�
GENERAL FEES Outdoor Liah a Standard C� $1
401 to 800 Am re 550
Above 800 Am re $75
CIRCUITS / FEEDERS
0 to 200 Am re $5
Above 200 Am re $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Exh S stem Device or atus $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units � S50 Per Unit
er Mp ile
MAY BE
( ���� �� (�I �� �i� �� ��) �) ��� �� �I� �� �I� �� ��� N� ��
16373680
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Inves6 ative Fee
Reins tion Fee $20
TOTAL FEE O L J�
(minimum total fee is $20) Q� '�� `�
iH15 ARFA FOR INSPECTOR USE OrkV
i hereby cer6fy thal I inspected the electrical installafion described herein on the dates stated:
-, l � , C"
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IF NOT COMPLETED WITHIN 12 MONTHS �
rceques[ ua[e: Rough-in Inspection Required? LJ Yes LJ No Inspedion Other Than Rough-In: LJReady Now ❑ Will Call
You must call the inspecta when ready! Date Ready:
i cerMy that I a the d�FNSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the elechical work at:
INSTRUCTONS ON BAGK OF YELLOW COPY BOARD OF ELECTRICRV COPY E&00001M14 8. t. 2002