P - 78005REQUEST FOR ELECTRICAL INSPECTION �
,���� O- 5 0 9� Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800�27-3529 www.electricity.state.mn. ur
0 NEW MODEL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy 'rf necessary - the work covered by this request:
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GENERAL FEES Outdoor ' htin Standard 51
SERVICES / POWER SUPPLIES Traffic Signal Standard �1$5
401to
Above
Transfortners
0 to 200 Am e E5 ONE & TWO FAM�LY DWELLINGS, EACH UNIT
Above 200 Am re $10 Includes ihe Senice andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING GrcuiLs and Two Inspection Trips Each Dwelling Unit � S80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Addi6onal Ins 6on Tri $20
Each S stem Device or atus $.50 Inves ative Fee
ADDITIONS TO THE GENERAL FEES Reins tion Fee $20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE
3 to 12 Units @$50 Per Unit (minimum toTal fee is $20) ,�
EaCh AddibOn21 Unit � E25 Twsu� raa asrECroa us� aar
I hereby certfy tlwt I inspected the electric� installa6on described herei� on tlie dahs st�ed:
OTHER ADDITIONAL FEES
Liahtina Retrofit � 5.25 cer Fixture
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�V� �e: Roughin I�spection Required7 ❑ Yes No Inspedion Oftier Than Roughan: ❑Ready Now VMII Cell
+ � � �Z 'Cl� You must call the inspecta when ready! Date Ready: C �y �`, _ . �y � �
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I certify tliat I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and heieby request inspectlon of the elechical work at: