P - 789451.-6��16-380 ❑7
❑ NEW ❑ REMODEL ❑ ADDITION REF
�; , er►U � � 3$'3d 7 - �
GENERALFEES
SERVICES / POWER SUPPLIES
0 to 400 Am ere $25
401 to 800 Am ere $50
Above 800 Am ere $75
CIRCUITS I FEEDERS
0 to 200 Amcere @ $5
Above 200 Ampere @$70
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
E�h System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL F
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$5� Per U�il
Retrofit � 5.25 cer Fixture
REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-8�7-3529 www.electriciry.state.mn.us
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2 Describe -using the back of the ' copy if necessary - the work covered by this request:
IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIiIIIIIIIII��'In�
16763807
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Traffic Sianal Standard
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
TOTAL FEE I �� �
(minimum total fee is $20)
THIS �RFA Fpt INSPECTOR USE ONLY
I hereby cerGfy that I inspec0ed the ek�ctric� insialla6on described herein on the da�es sta0ed:
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Request Dffie: Rough-in Inspection Requiredl ❑ Yes Inspection Other 7ryan Rough-In: y Now p yVAI Call
—2, You must call the inspeclor wh� ready! pa� R�y:
I certiry that I am ihe �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request insoection of the electriral rmrk at�
--.........�.....�n�..��.�..�rr . E&OOOD1M14 8.1.2002