P - 78902c REQUEST FOR ELECTRICAL INSPECTION
1� V��- 4 6 6� 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.us
NEW ❑ REMODEL ❑ ADDITION O REPAIR Describe -using the back of the white copy'rf necessary - the work covered by this request:
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CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or App�ffius �$.50
ADDITIONS TO THE GENER4L I
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units � S50 Per Unit
Each Additiaial Unit � E25
OTHER ADDITIONAL FEES
Li htin Retrofit $.25 er Fixture
Center Pivot Irrig�on Boom E4
Manufactured Home Park Lots
Recreational Vehicle P�k Sites
Se �ate Bondin Ins tion E20
Special Inspection (a2 $30 cer Hour
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1657466?
Traff�
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Trarisfortners u to 70 KVA $10 �
Transformers over 10 KVA $ 20
Transfortner I Power SuDdY for Signs I OuUine Lighting � ES
ONE & TWO FAMILY DWELIJNGS, EACH UNIT
Includes the Service aridlor Power Supply up to 500 Amperes, All
Circuits and Two Inspectlon Trips Each Dwelling Unit � S80
AddiGonal Inspection Trips $20
Investiaa6ve Fee
(minimum total fee is $20) � '
rMls,�nFn Fon wSPECTOa usE aar
I h�eby cerAfy Mat I inspected Ihe ekctrical inslalla6on descaibed herein on the daEes sta0ed:
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�Q� �: Roughin inspection Required? Yes No Inspection Otlier Than Rough-In: Ready Pbw � VWI Call
� �� You must call the inspeclor wh� ready! Date Ready.
I certi(y tl�at I am the ICENSED CONTRACTa2 ❑COA�ANY ❑ OWNER and hereby �equest inspection of U�e electrical wak at: