P - 78147REQUEST FOR ELECTRICAL INSPECTION
1* � v�—��� a g'21�Unrv rsity A enue 3uite S- 28, SaiM Paul, Minnesota 55104
• (651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
❑ NEW ❑ REMODEL ❑ ADDITION REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
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GENERAL
SERVICES I POWER SUPPLIES
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
Lighfing Retrofit @ $.25 per Fixture
Center Pivot Irrigation Boom � $40
Manufactured Home Park Lots � $
RecreaGonal Vehicle Park Sites fa ;
I�IA �) Ili I� III II III I� III II �II II III II III �� I�I
15825284
$1
Traffic Signal Standard
Suoolemental Fee Cd S
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service �dlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
TOTAL FEE
(minimum total fee is $20) 3B, s�
iM15 AREA Fqt INSPECiOR USE OMY
I hereby certify that I inspected the electrical installa6on described herein on the dates stafed:
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�IPLETED WITHIN 12 MONTHS �
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Request Dffie: Rough�n Inspection Required? ❑ Yes No Ins
pection Other Than Rough-In: ❑Ready N dl Call
*� ���'D You must call the inspecta when ready! Date Ready:
I certify that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby iequest inspection of ihe elecfical work at::