P - 78040'7 '7 REQUEST FOR ELECTRICAL INSPECTION
1� 5 4 8� 1� 1 � Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 T'fY/MRS 1-600-627-3529 www.electricity.state.mn.us
❑ NEW ❑ RE EL O A ITIO�� Describe sin the bxk of the white opy ff necess � e work covered by this request:
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GE ERAL FEES Ou door ' tina Standard �il S
VICES I POWER SUPPLIES
0 to 400 Amcere � E25
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or ratus $.50
ADDITIONS TO THE GENERAL FEES
to 12 Units @$50 Per Unit
�ch Additional Unit @ $25
OTHER ADDITiONAL FEES
� Retrofit @ $.25 per Fixtu2
Pivot Irrigation Boom @ $40
ctured Home Park Lots $25
tional Vehicle Park Sites � S5 •
�_ Transfortner! Power Supply for Sions I Oulline Li9htinq $5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Senice andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Reins tion Fee $20
TOTAL FEE �,
(minimum total fee is $20) /C
iH15 AREA FOR INSPECTp2 USE OI/Y
1 hereby certify that I inspecOed the electrical installation described herein on the dates staled:
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I certify that I am ihe
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Roughin Inspection Required? ❑ Yes ❑ No Inspedion Othw Than Rough-In: y Now ❑ Vyfll Call
You must call the inspecta when ready! Date Ready.
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request inspection of the electrical work at::
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