P - 79278. ❑ REQUEST FOR ELECTRICAL INSPECTION
r� r I��_ 5 2 5 Q 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
� NEW 0 REMODEL ❑ ADDITION 0 REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
� �CEI. E�lERC�Y SFt�l��?'� SVtf�TG�
0 to 4Q0 Am re $25 Su lemental Fee $2D
401 to 800 Am re $50 Transformers u to 10 KVA $70
Above B00 Am re $75 Transformers over 10 KVA $ 20
CIRCUITS / FEEDERS Transformer I Power Su for Si ns I Outline Li hGn $5
0 to 200 Am re $5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re $10 Includes 1he Service and/or Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit @$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Addifinnal Insnec:tion Trios al� 32�
Fee
ADDITIONS TO THE
3 to 12 Units @$50 Per Unit (minimum total fee is $20J � $24,50
E2Ch Addltio1181 Unit @ $25 rHisuuaFa+irisaECTOauseaar
I hereby ceitify that I inspected the electrical installa6on described he�ei� on tlie dates sta6zd:
OTHER ADDITIONAL FEES
Liahtina Retrofit (� 825 cer Fixture �� G�� "" �'% 7 3�-
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Request Date: Rough-in Inspection Required? ❑ Yes C�AIO lnspedio� Other Than Rough-!n: Qf3eady Now O wdl Catl
��l20(� You must call the inspecta when readyl Dale Ready.
I certity that I am the Cj�.ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of ihe elecfical work aY.:
IN87RUC7tON8 ON 6ACK OF YELLOW COPY eon� oF e�crnicm coPV Ed-�„k„ n.,. �