P - 79312�� REQUEST FOR ELECTRICAL INSPECTION
� � � � � � [ � r� � Minnesota Board of Electricity
J G 1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
(651) 642-0800 TfY/MRS 1-800-627-3529 www.electricity.state.mn.us
NEW ❑ REMODEL O ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
3fGEL EPIERGY SRVER'S SIMTCN
/POWER
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CIRCUITS / FEEDERS Transfortner / Power Su I for Si ns / OuUine Li htin $5
0 to 200 Am re $5 ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re $10 Includes the 5ervice andior Power Supply up to 500 Amperes, All
ALARM, COMMUNICATiON, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit @$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins tion Tri s $20
Each Svstem Device or Anoaratus (� 5.50 Investiaative Fee
TIFAMILY DWELIINGS PER UNIT TOTAL FEE I
3 to 12 Uni� @$50 Per Unit (minimum total fee is $20) $20.50
EaChAddiGonalUnit@$25 iHLSMERFdiIPLSPECipiUS aar
. I hereby cerVy thal I inspected the electrical installadon described herdn on the dates sfated:
OTHER ADDITIONAL FEES � O Q�` Q� 7Q �
Li9hGns1 Rehofit �$.25 Der Fixture L
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1 li� h I� 11 fH If � fl 11111 �Il I�I li �
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I Fiequsst Date: I Rough�n Inspection Required? ❑ Yes OTb Inspedion Other Than Rough-In: �10�ady Now � Will Cell I
Q�(2Qf (� You must call the inspector when ready! Date Ready:
I certify that I am the L�ICENSED COiJTRACTOR ❑COMPANY ❑ OWNER and hereby request inspection of 1he elechical wo�C at: