P - 78139REQUEST FOR ELECTRICAL INSPECTION
1��� o- 2 5 0 5❑ Minnesota Board of Electricity
1821 University Avenue Suite S-128, SaiM Paul, Minnesota 55104
��� � � (651) 642-0800 TlY/MRS 1-800-627-3529 www.electricity.stote.mn.us
❑ NEW REMODEL 0 ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the work crovered by this request:
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GENERAL EES Outdoor Li htin Standard E1
SERVICES I POWER SUPPLIES Tra(fic Si nal Standard E5
0 ta 400 Am re $25 Su lemental Fee $20
401 to 800 Am a50 Tr�sfortners u to 10 KVA E10
Ahove 800 Am re S75 Tr�sformers over 10 KVA S 20
I CUITS I FEEDERS Transformer I Power Su I for Si ns I Outline Li hGn $5
0 to 200 Am re E5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am S10 ^ Includes tl�e Service �dlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING CircuiLs and Two Inspection Trips Each Dweliing Unit �$60
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS a��n��� i„�„o„n�� r��� n e�n
ADDITIONS TO THE GENERAL
fIFAMILY DWELLINGS (PER UNIn
3 to 12 Units � E50 Per Unit
Each Addition� Unit @ E25
OTHER ADDITIONAL FEE:
Lighting Retrofit @ $.25 per Fixture
Center Pivot irtiaation Boom (d S40
IN� II � I� III II III II III II III II III II �I U� I�
15902505
TOTAL FEE I �
(minimum total fee is $20) �Q/
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I hereby certiy th� I inspec�ed the electrical ir�staNa6on described herein on tl�e dales staEed:
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�V �� Roughin Inspection Required? ❑ Yes Ins
� ( pection Other Than Rough-In: ❑Ready Now WNI Call
`.3 � You must call the inspecta when ready! Date Ready. .
I certify that I am the LICENSED CONTRACTOR ❑COMPANY ❑ OWNER and hereby request inspectiai of the electrical work at: