P - 78983'] REQUEST FOR ELECTRICAL INSPECTIQ�f
1� 6 9 3� o� 1 � Minnesota Board of Electricity -
1821 University Avert�e Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricitystate.mn.us
❑ NEW ❑ REMODEL ❑ ADDITION REPAIR Describe -using the bapk of the white copy if necessary - th�work covered by this request:
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SUPPIIES
� $25
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each 5 stem Device or A aratus $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
Center Pivot
Transformers u to 10 KVA $10
Transformers over t0 KVA $ 20
Transfortner I Power Su I for Si ns I OuGine Li htin $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Vncludes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$BO
Addi6onal Ins Gon Tri s $20
Inves6 ative Fee
Reinsoection Fee (a� $20 �/
a.
TOTAL FEE �/ c�
(minimum total fee is $20) yD' J C�
THIS MFA FOR INSPECTOR USE plv
I her y ceAify that I inspected tlie electrical insUlla6on described herein on the dates sfaled:
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Request Date: Rou9hin Inspection Required? ❑ Yes No Inspection Other Than Rough-In: ❑Ready Now NRII Ca0
�`� � Q y You must call the inspector when ready! Date Ready. ./+/ �.Q Y
I certify that I am the �CENSED CONTRACTOR ❑COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Site Address (Street, Box, a Route No.) t ZP �
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ON BACK OF YELLOW COPY �/ /BOARD OF ELECTRICITV CAPV
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License Number
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E&00001M14 8.1.2002 -.