P - 789521-6�7-471 ❑7
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❑ADDITION ❑
c� � 1
GENERALFEES
0 to 400 Ai
40110 B00
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aooaratus � 5.50
REQUEST FOR ELECTRICAL INSPECT{ON
Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 -
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us
4 Describe -using the back of the white copy if necessary - the work covered by this request:
Transformers u to 10 KVA $10
Transformers over 10 KVA $ 20
Transformer / Power Supply for Signs I Outline Lighting @$5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, Ali
Circuits and Two Inspection Trips Each Dwelling Unit @$80
ADDITIONS TO THE GENERAL FEES Reins uon ree m b[u
fIFAMILY DWELLINGS PER UNI TOTAL FEE �
3 to 12 Units @$50 Per Unit (minimum total fee is $20) �•
E2ChAdd160f181Un1t@$25 THLSMFAfORINSPECTOqU$EptY �
I hereby ceAiy that I i the electrical insUllafio� described herein on the da0es sta0ed:
OTHER ADDITIONAL FEES � u �'_" �� '�r` '.�dG�.. O (�ri ��
Liahtina Retrofit � 5.25 oer Fixiure
Ilil II III II III II Ill II Ili Il lil II lll f I III �� I�
1 6 5 7 4 7 1 7
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Request e: Roughin Inspection Required? ❑ Yes No Inspedion Other Than Rough-In: dy �bw � VWI Call
��y//�y You must call the inspector when readyl Date Ready: �//y/�
i certify that I am the�CENSED CONTRACTOR ❑COMPANY ❑ OWNER and hereby request inspection of Ihe electricxl work at: