P - 78412������ REQUEST FOR ELECTRICAL INSPECTION
�—�, 9?� g g q. � Minnesota Board of ElecVicity
1821 University Avenue Suite S-128, Sairrt Paul, Minnesota 55104
(651) 642-0800 TlY/MRS 1-800-627-3529 www.electricity.state.mn.us
❑ NEW REMODEL 0 ADDITION ❑ REPAIR Describe -using t e back of the white copy if necessary - the work covered by this request:
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GENERAL FEES Outdoor Ligh6ng Standard @$1
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or ratus $.50
ADDITIONS TO THE �ENERAL FEES
MULTIFAMILY OWELLINGS PER UNI _
3 to 12 UniYs �$50 P� Unit
Each Additional Unit � $25 -
OTHER ADDITIONAL FEES
' htin Retrofit $.25 r Rxture
Center Pivot Irri a6on Boom S40
Manufactured Home Park Lok $25
Recreational Vehicle Pak Sites $5
rate Bo�in Ins 'on $20
S i� Ins tibn $30 r Hour
Soeci� Insoection � $.31 cer Mile
Transformers uo to 10
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andla Power Supply up to 500 Amperes, NI
Circuits and Two Inspection Trips Each Dwelling Unit �$80
TOTALFEE �
(minimum total fee is $20) (� �� S
TH6 MEA FOR INSPECTdi 16E OILY
I hereby cer�(y that I inspec0ed the elec6ical insplla6on deuribed herein on tlie dates sf�ed:
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Req�t Date: Rough�n Inspection Required? ❑ Yes Inspeclion Oth� Than Rough-In: ❑Ready Now Will Call
v` 1,�•. �C.�� You must ca�l the inspector when readyl Date Ready:
I certify that I am the �LICENSED CONTRACTOR ❑ CON�ANY ❑ OWNER and hereby request mspection of fhe electrical worlc at: