P - 78045'� REQUEST FOR ELECTRICAL INSPECTION
115 4 4- 619 8❑ Minnesota Board of Electricity
1821 University Avenue Suite S-128, SaiM Paul, Minnesota 55104
�Sll� (651) 642-0800 TTY/MRS 1-800�27-3529 www.electriciry.state.mn.us
❑ NEW EMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
Q i l�, l' /�.. iC.u� / G i_ /i�l ��%!ld_G
401 to 800 Am ere E50
Above 800 Ampere � S75
CIRCUITS I FEEDERS
0 to 200 Am re $5 !
Above 200 Ampere @$10
ALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS, CIRCUITS OF �ESS THAN 50 VOLTS
Each Svstem Device or Aooarffius Cd 5.50
Su lemental Fee $20
Transfortners u to 10 KVA y10
Tr�sfortners over 10 KVA $ 20
Transfortner / Power Su I for Si ns / Outline Li htin $5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Addi6onal Inspection Trips @ $20
Investiqa6ve Fee
MULTIFAMILY DWELLINGS PER UNIT TOTAL FEE n! � Tl )
3 to 12 Units @ g50 Per unit (minimum total fee is $20) pCJ ��
E2ch Addi6onal Unit @$25 r�is u�n Fors uu�croa usE aa.
I hereby certify ihat I inspecled tt�e electrical instaNa6on described herein on the dates stated:
OTHERADDITIONALFEES Ky� i/-L"�
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Park Sites
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Request Date: Rough-in Inspection Required? ❑ Yes No Inspection Other Than RougMn: ❑Ready Now �'Will Call
� 6'v3 You must call the inspector when ready! Date Ready:
I certify that I am the �CICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the elecVical work at::
�na�n��. �n�na un eAt:1� UF �CLLOrII GUP7 BOARD OF ELECTRICITV COPV EB-00001A-14 8.1. 2002