P - 77696C�j REQUEST FOR ELECTRICAL INSPECTION
1� V J�- 6 51 � Minnesota Board of ElecVicity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
��Q� (651) 642-0800 TTY/MRS 1-800�27-3529 www.electricity.state.mn.us
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❑ NEW ❑ REMODEL� 0 ADDITION ❑ REPAIR Des,�p�g -using the back of the white copy if necessary - the work covered by this request:
CIRCUITS Of LESS THAN 50 VOLTS
ystem Device or Apparatus @ $.50
ADDITIONS TO THE GENERAL FEES
3 to 12 Units �i,l $50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Lighting Retrofit @ E.25 per Fixture
Center Pivot Irtigafion Boom @ $40
Manufxtured Home Park Lots C� S25
Hour
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16386518
Su lemental Fee $20
Transformers u to 10 KVA (� $10
Transformers over 10 KVA $ 20
Transformer I Power Su I for Si ns / OuUine Li htin $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes ihe Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$80
Additional Inspection Trips @ E20
Investiaative Fee
(minimum total fee is $20) 0� (J ,
iH1S ARFA FOR INSPECTOR USE ONv
I hereby cerEry that I inspected the electrical installa6on described herein on the dates stated:
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COMPLETED WITHII
uest u^ate�� Roughin Inspection Required? ❑ Yes '7� No Inspedion Other Than Rough-In: ❑Ready Now/$ Will Call
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d�) You must call the inspecta when ready! �� Date Ready:
I certiry that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby iequest inspecfion of the electrical work at::
Job Site Address (Street Box a Roule No.) ZiP Code
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EB-00001A-11 8.1.2002