P - 78052C�y(� REQUEST FOR ELECTRICAL I SPECTION
1� J G J- 0 31 ❑5 Minnesota Board of Electricity �Q /S
1821 University Avenue Suite S-128, Saint Paul, inTSeSota 55104
(651)642-0SOOITY/MRS 7-800-627-3529 .el .mn.us
❑ NEW ❑ REMODEL ❑ ADDITION REPAIR DesCribe -using the back of the white copy if necessary - th xro v red by this request:
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GENERAL FEES Outdoor Li htin Standard $1
SER ,ICES / POWER SUPPLIES Traffic S' nal Standard $5
400 Am re $25 Su lement� Fce $20
401 to 800 Am re $50 Transiortners u to 10 KVA $10
Above 800 Am re E75 Transformers over 10 KVA $ 20
C RCUITS I FEEDERS Transformer / Power Su I for Si ns I OuUine Li htin $5
0 to 200 Am re $5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re $10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALIN� Circuits and Two Inspection Trips Each Dwelling Unit @$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins tion Tri s $20
Each S stem Device or Apparatus @$.50 Inves6oative Fee
3 to 12 Units
Each Addi6o
Lighting Rehofit
Center Pivot Irtii
TOTAL FEE I �a
_ (minimum total fee is $20) �
Tws u+en �on rtaaECrca usE ora
I hereby certify that I inspected the electrical insUllation described herein on the dafes sfaled:
5 iallns 'on $.31 Mile
_,THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT
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Request Date: Rouqh�n Inspection Required? O Ves No Inspedion Other Than Rough-In: ❑Ready Now I Call
/�� v'�Q� Vou must call the inspector when ready! Date Ready:
I certi(y that I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspecti�on of the electrical work at:
Job Site Address (Street, Box, or te No.) qty ZiP Code
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IN3TRUC7tON3 � BACK OF YELLOW COPy gpApp pF ELE Ry CppY E&OOOp1M14 8.1. 2002