P - 78892REQUEST FOR ELECTRICAL INSPECTION
1� V V�-13 2� Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
� �� (651) 642-0800 TlY/MRS 1-800�27-3529 www.electricity.state.mn.us
❑ NEW REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy 'rf necessary - the xrork covered by this request:
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GENERAL FEES Outdoor Li htin Standard $1
SERVICES / POWER SUPPLIES Traffic Si nal Standard $5
0 to 400 Am re $25 Su lemental Fee $20
401 to 800 Am re $50 Transformers u l0 10 KVA $10
Above 800 Am re$75 Transformers over 10 KVA $ 20
�IRCUITS / FEEDERS _ 1 . Transformer I Power Suoolv for Sians / Outline Liahtina �$5
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
GENERALFEES
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspe�:tion Trips Each Dwelling Unit �$80
Addifional Inspec6on Trips � $20
Inves6aative Fee
3 to 12 Units �$50 Per Unit (minimum total fee is $20) pCU �`�
E2Ch Addifi0�21 Unif �$25 rins ueEn wrs irase�cTan usE «ar
I hereby cerbq that I inspec6ed the electrical ir�falW6on desaibed herein on the d�es staBed:
OTHER ADDITIONAL FEES �G p(� � Q j 3�
Li htin Rehoffi $.25 r Fixt re
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ReQues► Date: � ( Rough�n Inspection Required? ❑ Yes No Inspection Other Than Rough-In: ❑Ready Now 11 Call
��) -Q`-C You must call the inspector when ready! Date Ready.
I certify that I am the �I ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at: