P - 75525` - 'v REQUES� FO� �t�CTRICAL INSPECTION
2° 0 6 4���� � Minnesota Board of Electricity
1821 Universily Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-OS00 TTY/MRS 1-800-827-3529 www.electricity.state.mn.r.rss
Describe -' e back of the white copy ff necessary - the covered by this re.qu�st ^
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GENERAL FEES Outdoor Liahtina Standard f�a $1
IALARM, CAMMUNICA170N, REMOTE COP1TROl
CIRCURS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aooaratus (a� 5.50
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Sup lemerdal Fee @ $20
Tiansfortners u to 10 KVA �c $10
TiansFomrers over 10 KVA c$ 20
Tiansformer / Power S I for Si rts / Outl'me ' $5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Inciudes the Service and/or Power Supply up to 500 Amperes, M
Circufts and Tvro Inspecfion Trips Each Dwellir�g Unit @$80
� ReinspecUon Fee @ $20
TOTAI
(minimum total fee is
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I Irereby certlfy tlmt I Irepected the elecMml
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nspacdon Other Than Rough-In: � Ready Now 0 WtlI Cell
g�_r You muet call the inspector whe � dyl Date Ready.
I certiify that I am the ❑ UCENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request ins�ction of the el�hical wi�rk at
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