P - 78033REQUEST FOR ELECTRICAL INSPECTION
1��� 6�� 8 9 � Minnesota Board of ElecUicity -
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
❑ NEW EMODEL 0 ADDITION ❑ REPAIR Describe -using the bxk of the white copy if,neces5ay - the work covered by this reguest:
SERVICES I POWER SUPPLIES
0 to 400 Am ere S25
401 to 800 Am re $50
Above 800 Am re E75
CIRCUITS / FEEDERS
0 to 200 Am re $5
Above 200 Am re $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or ratus $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
31012 Units � $50 Per Unit
Each Additional Unit @ $25 ' ` e:
OTHER ADDITIONAL FEES
Li htin Rehofit $.25 Fixture
Center Pivot Irti aGon Boom $40
Manutactured Home Park Lots $25
Recreational Vehicle Park Sites $5
Se arate Bondin Ins tion $20
Soecial Inscec6on � S30 cer Hour
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15263890
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes ihe Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspec6on Trips Each Dwelling Unit @$80
Additional Insoec6on Trips (d $20
Inves6 ative Fee
Reins 6on Fee $20
TOTAL FEE
(minimum total fee is $20) � - "
THIS MEA Fp21N5PECTdE USE plY
I hereby ceAify Mat I inspected the electrical insfall�on described herein on the dafes stated:
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�ED IF NOT COMPLETED WITHIN 12 MONTHS ___
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Request Date: Rough-in Inspection Required? �Yes ❑ No Inspedion Other Than Rough-In: ❑Ready Now�Will Call
( I— t 9'—a3 You must call the inspeda when�rzdy! Date Ready:
I certify that I am the '�-EIEENSED CONTRACTOR ❑ COMPANY 0 OWNER and hereby request c�spection of the elechical work at: