P - 78834REQUEST FOR ELECTRICAL INSPECTION
1��} V�� - 5 9 8� 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 ❑ REPAIR Describe -using thee back of the'whitne copy if necessary - the work covered by this request:
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GENERAL FEES Outdoor ' htin Slandard $1
SERVICES I POWER SUPPLIES Traffic S' nal Standard $5
0 to 4� Am E25 Su mental Fee $20
401 to 800 Am E50 Transfom�ers u to 10 KVA $10
Ahove 8� Amoere � E75 Transfortners over 10 KVA � E 20
CIRCUITS OF LESS THAN 50 VOLTS
ADDITIONS TO'
MULTIFAMILY DWELLINGS PEI
3 to 12 Units �$50 P�x UnR
Each Additional Unit � E25
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14'655989
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspecbon Trips Each Dwelling Unit � EBO
(minimum total fee is $20) � �"� �
THS MEA FOR MISPECTpt USE OKY
I hereby cer6fy tl� I inapet�d the electrical instala6on described herein on Ihe d�es st�d:
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�Date: Rough-in Inspection Required? �Yes ❑ No Inspection Other Than Rough-In: ❑Ready Now LJ VY�fI CaU
��� 0 3 You must call the inspector wh� ready! Date Ready.
I certify that I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ ONMER and hereby request inspeclion of ihe dectrical work at: