P - 76308� REQUEST FOR ELECTRICAL INSPECTION ���
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1'� �� ���� 7 � Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 -
��"� .(651) 642-0800 TTY/MRS 1-800-627-3529 www.edectricity.state.mn.us
Describe -using the back of the white copy ff necessary - the work covered by this requatit:
F�- 1/� I�T � � �
GENERAL FEES Outdoor Lighting Standard @$1
SERVICES I POWER SUPPLIES TraRc Si nal Standard @$5
0 to 400 Ampere @$25 Su plemental Fee @$20
401 to 800 Am re$50 Transformers u to 10 KVA $10
Above 800 Am re $75 Transfortners over 10 KVA $ ZO
CIRCURS / FEEDERS Transfortner / Power Su I fm Si s/ Outline Li ' $5
0 to 200 Am re $5 / ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re$10 Includes the Service andlor Poarar Supply up to 500 Amperes, M
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Txro Inspection Trips Each Dwelling Unit @$60
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Addi�onal Ins on Tri $20
Each System bevice or Apparatus @$.50 Imestipative Fee
Inits @ $50 Per Unit
di�onal Unit @ $25
OTHER ADDITIONAL
Retrofit C�a. $25 aer Fixture
Hour
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�m total fee is
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electrical irefaila8on de�aibed herefi on the deGes smffid: I
�OP, OFFiCE USE UNLY
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"a`B' Rough-in Inspectlon R uired7 ❑Yes I�
eq �on Other Than Rough-In: 0 Readq Call
___I� ���� Yau must wIl the inspector when readyl Date Ready.
I certify that I am the�'iLICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request mspection of the electrical work at
Job Site Street Address CitY
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Lice�e Number Master ElectrlGan or P
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Please Pra e Two (2) Phone Numbers I
�Osi) K5d- a3S� ( )