P - 78938c"7 REQUEST FOR ELECTRICAL INSPECTION
1�6 2 6� O V ( � Minnesota Board of Electricity � _
���� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-OSQO TTYlMRS 1-500-627-3529 www. electriciry.state. mn. us
0 NEW �2EMODEL ❑ ADDITION ❑ REPAIR Desc�be -using the back of the white copy if necessary - the work covered by this request:
GENERAL FEES Outdow L' hGn Standard $1
SERVICES I POWER SUPPLIES Traffic Signal Standard @$5
401 to 800 Am ere $50
Above 800 Am ere �, $75
CIRCUITS / FEEDERS
0 to 200 Am re $5
Above 240 Am re $10
ALARM, COMMUNICATION, REMOTE CONTROI
CIRCUITS, CiRCUITS OF LESS THAN 50 VOLTS
Each Addifional Unit
Retrofit
Boom
Iill I{ (II II {il {I I(i ii 611 N III N �ll fl 111 �� I�
1 6 2 6 0 6 7 1
Transformers u to 10 KVA $10
Transformers over 10 KVA p$ 2�
Transformer ! Power SuDPIy for Sipns ! Outline Lighting @$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Incfudes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
(minimum total fee is $20) � O'�Ci '
THIS MFA Fqi 115PEC10R USE ON.Y
I herehy certiry that 1 inspec�d Me electric� inst�f�on described herein on tlie dartes stated:
1
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o�f�-CL�S�� �� -S �
I�4� �e: Rough-in Inspaetion Required? ❑ Yes �IQO InspectlYwi Other Than RougMn: �Ready Now (�WGI Cali I
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-- j`ra You must call the inspecla when ready! pate Reedy,
I certify fhat I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request mspection of the elec6ical work at: