P - 77481REQUEST FOR ELECTRICAL INSPECTION -�� ��
2� O 2� w�� 2 � Minnesota Board of Electricity �-;
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
D cribe -using the bac f the w ite copy if necessa - the work covered by this request:
VYl -e � � o - n-2 C-e SS �; � � � I��a
GENER4L FEES Outdoor Lighting Standard $1
SERVICES I POWER SUPPLIES Traffic Signal Standard @$5 _
CIRCUITS / FEEDERS
0 to 200 Am ere $5
Above 200 Am ere a$10
ALARM, COMMUNICATION, REMOTE CANTROL.
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or Ap aratus $.50
ADDITIONS TO THE GENERAL F
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unii
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Li hting Retrofd $.25 r Fixture
Center Pivot Irti ation Boom $40
Manufactured Home Park Lots C�D $25
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additional Inspection Trips @ $20
Investiaative Fee
total fee sL$20) I �'� ��� I
I hereby cerfify that I inspecled the elechical installa6on desaibed herein on the dates stated:
RWGHIN �. DAIE
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FiNAlINSPECTION . + / DRTE
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T.HIS INSTALLATJON MAY BE ORDERED DI�CONNEGTED IF NOT COMPLETED WITHIN-12 MONTHS _
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Date: Rough-in Inspection Required? ❑ Yes ❑ No Inspection Other Than Rough-In: ❑ Ready Now�Will Call
�^ ��� U� C!/ You must call the inspector when ready! Date Ready:
I certify that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ 0 NER nd hereby request inspection of the electrical work ai
Job Site SVeet Address ��Y
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Two (2) Phone umbers Induding Area Cod
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Master ElecUician or Po er Limited Tech�
License Number
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Please Provide wo (2) Phone Numbers Indudmg An
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EB-00001A-