P - 78430REQUEST FOR ELECTRICAL INSPECTION
1� 4 9 4- 0 3 3� Minnesota Board of Electricity -
1621 University Avenue Suite S-128, Saint Paul, Minnesota 55704
(651) 642-0800 T'fY/MRS 1-800�27-3529 www.e[ectricity.state.mn.us
❑ NEW ❑ REMODEL ❑ ADDI ❑ RE AIR Describe -usi the back of the white copy if necessary - the xrork covered by lhis request:
GENERALFEES
I POWER SUPPLIES
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A aralus E.SO
ADDITIONS TO THE GENERAL FEES.
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
' htin Retrofit E.25 r Fixture
Center Pivot Irriaation 800m � S40
Traific Siqnal Standard
Includes the Service andlor Power Supply up to 500 Amperes, All
Cirouits and Txro Inspection Trips Each Dwelling Unk � E80
Addi6onal Inspection Trips � $20
Investiaative Fee
(minimum total fee is $20) ( /'X(J•3 i
rHa u�n Fat rcarECTOrt usE arar
I hereby cerliry that I i�pected the elechical ir�taNadon desaibed herem m tlie d�s staBed:
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RWu�t Date: �� Roughin Inspection Required? ❑ Yes ❑ No Inspection Other Than Rough-In: Now O WNI Cafl
• � You must call the inspector when ready! Date Ready.
I certify ihat I am the ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request mspection of the electrical wak at:
Job SCtd ( Box, or Route No.) C w Zp Code
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INS7RUC".ONS ON�/1CK OF
BOARD OF ELECTRICITY COPY
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E&00001M14 8.1.2002