P - 78748REQUEST FOR ELECTRICAL INSPECTION �
1- 4 7 7- 6 2 6� Minnesota Board of Electricity - :
1821 University Avenue Suite S-128, SaiM Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electriy�iry.�tate.rr�n.us
❑ NEW ❑ REMODEL ❑ ADDITION REPAIR Oescribe -using the back of the white copy if necessary - the work covered by this request:
FEES
401 to B00
ALARM, COMMUNICATION, REMOTE CONTROL, SIGI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus � E.50
ADDITIONS TO THE GENERAL FEES
3 to 12 Units �$50 Per Unit
Each Additional Unit @ $25
IINI IIIiI Ilill IIIII IIIII 1111111111IIIII �� II�I
14776264
Traffic Si nal Standard 85
Su demental Fee $20
Transfamers u to 10 KVA $10
Transformers over 10 KVA $ 20
Transfortner I Power Su for Si ns I OuUine Li htin $5
ONE & TWO FAMILV DWELLINGS, EACH UNIT
Includes ihe Service ar��dlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additional Inscection Trios � $20
( TOTAL FE; I �j/j��
minimum total fee is $20 � � ��
TMS RREA Fpi WSPECTOfi USE ONLY
I 1�2by cer6ty Mat I inspecled the electrical instaNNa6on described herein on Me da0es st�ed:
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30396
Rough-in Inspectlon Required? 0 Ves ❑ No I InspeUia� Other Than Rpigh-In: eady Now O Will Call
You must call the i�spector when readyl pete Re�Y
NSED CONTRACTOR �$COMPANY ❑ OWNER and heieby request mspection of ttie electrical work at:
D181R11C710N8 ON BACK OF
EB•00007M14 8.7.2002