P - 79232REQUEST FOR ELECTRICAL INSPECTI�N
� r i V�- 5 6 3 Q Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
u (651) 642-0800 TTY/MRS 1-800-627-3529 www.e lectricity.state.mn.us
NEW ❑ REMODEL ❑ ADDITION 0 REPAIR Describe -usin the back of the white copy if necessary - the work covered by this request:
}(CEL. EtVERGY SAVEf�'8 SWlTCH
GENERAL FEES Outdoor Li htin Standard $1
SERVICES / POWER SUPPLIES Traffic Siunal Standard C�? $5
0
CIRCUITS / FEEDERS Transformer 1 Power Su fa Si ns I Outline Li hGn $5
0 to 200 Am re $5 ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re $10 includes the Service andlor Power Supply up to 500 Amperes, All
AIARM, COMMUNICATION, REMOTE CON7ROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit @$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Insaection Trios Cd $20
fIFAMILY DWELLINGS PER UNIT TOTAL FEE I 2O,SQ
3 to 12 Units @$50 Per Unit (minimum total fee is $20)
E2Ch Addition8l Unit @ $25 TwsnaEr.FOa�croausEaar
� I hereby certify Mat I inspetted tlie electrical installa6on described herein on the dates st�d:
O7HERADDITIONALFEES 2� �`�r(,��
I inf.finn Rn4rnfif /n� C �F nu. Civh�w � l
PBI�f S11@S
Hour
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1 7 6 8 5 6 3 7
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rcequesc vace: Rough-in Inspection Required? ❑ Yes Inspection Other Than Ragh-In: ❑ dy Now � Will Call
07��� You must call the inspector when reatly! Date Reatly�
I certify ihat I am the �(ICENSED CONTRACTOR C7COMPANY ❑ OWNER and hereby request inspection of tlie electrical work ai:
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