P - 78080� ❑ REQUEST FOR ELECTRICAL INSPECTION
1 J 5 4� O�� � Minnesota Board of Electricity
1821 University Avenue Suite S-128, SaiM Pau in 55104
(651) 642-0800 TTY/MRS 1-800�27-3529 iciry.state.mn.us
NEW ❑ REMO L ADDITtON O R Describe -using the back of the white copy rf necess - the wak covered by this request:
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GENERAL FEES putdoor Uohtina Standard E1
VICES I POWER
0 to 400 Amcere
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
_ Exh System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL F
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
Fixture
Home
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15540362
Su lemental Fee E20
Transformers u to 10 KVA $10
Transfortners over 10 KVA $ 20
Transiomier I Power Su for S' ns / OuUine Li h6n 35
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes ihe Service andlor Paxer Supply up to 500 Amperes, All
CircuiGs and Two Inspection Trips Each Dwelling Unit @$80
Additional Inspection Trips p $20
� Investiaative Fee
( TOTAL FE j I F/� O i<✓L J
minimum total fee is $20
.ws u�n Fav ies�croa usE aar
I hereby certify that I inspecfed the electrical insiallation described herein on the dates sfffied:
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IF NOT COMPLETED WITHIN 12 Mi
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R6'+'�" e: Rough-in Inspeciion Required? ❑ Yes �No Inspectian Other Than Raugh-In: eady Now 0 yyfll Call
� � � You musl call the inspector when ready! pate Ready:
I certify t I am the f�ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby reqt�st inspectlon of tlie electrical work at:
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