P - 77738REQUEST FOR ELECTRICAL INSPECTION
1� 7 3 8— 6 0 8 ,� Minnesota Board of Electricity -
u 1821'University Avenue Suite S-1 ' Paul, Minnesota 55104
(651) 642-0800 TlY/MRS 1 2- 9 www.electricity.state.mn.us
0 NEW ❑ REMODEL ❑ AD TION E Describe -using the back of the ite copy'rf necessary - covered by this request:
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GENERAL FEES Outd r htin St�dard $1
SERVICES I POWER SUPPLIES Traffic Si nal Standard $5
0 to 400 Am re $25 Su lemental Fee $20
40110 800 Ampere �? $50 Transfortners uo to 10 KVA C� S10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A ratus $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Li h6n Retrofit $.25 r Fixture
Center Pivot Irrioation Boom � $40
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17386087
ONE & TWO FAMILY DWELLINGS, EACH UNfT
Includes the Service andlor Paver Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$80
TOTAL FEE '� �
(minimum total fee is $20) �
iH15 AREA Fd21NSPECipi USE ONY
I hereby ceAify Mat I inspected the electrical insialla6on described herein on the da0es sfated:
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OMPLETED WITHIN 12
eteque at �/� /� _� Rough�n Inspection Required? ❑ Y Inspedion Other Th:
C�l� J You must call the inspector when ready! Date Ready: /-�
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I certi(y that I am the ❑ LICENSED CONTRACTOR OCOMPANY ❑ OWNER and hereby
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II Call
ection of the electrical work at:
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onvactor �se numo1e�r nnaster �ectridan or
�n '/►f / C v V License Number
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INS7RUCTONB ON BACK OF YELL OPY BOARD OF ELECTRICITY COPV EB-OOOOtA-14 8.1. 2002