P - 78164[ REQUEST FOR ELECTRICAL INSPECTION
1� 5 J 1� 4 3 2 a Minnesota Board of Electricity -
1821 University Avenue Suite S-128, SaiM Paul, Minnesota 55104
(651) 642-0800 TlY/MRS 1-800-627-3529 www.electricity.state.mn.us
NEW /0 REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of ihe white copy'rf necessary - the work covered by this request:
GENERAL
✓ICES / POWER
0 to 400 Amcere
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or atus $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL FEES
htin Retrofit b.25 r Fixture
Center Pivot Irriaation Boom � $40 _
Trafic Sanal Standard
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes fhe Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
TOTALFEE Q
(minimum total fee is $20) ��
THIS/REA fIXt INSPECTOR USE ON.Y
I hereby certy tlwl I inspec�ed the electrical installafion described herein on the dates sq0ed:
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� �n�5 �nS�ALLAIIUIV MAr !3t UKUERED DISGONNEGTED IF NOT COMPLETED WITHIN 12 MONTHS (
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�e= Rough-in Inspection Required? ❑ Yes Inspedion Other Than Rough-In: Ready Now O Will Call
'� 3 O'� You musl call the inspector wFien readyl Date Ready:
I cefify that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
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Master EJectrician or Power Limited Technician .
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INSTRUCTONS ON BACK OF YE� � BOARD OF ELECTRICITV �.-w� ` EB-00001A-14 8.1.2W2