P - 77571REQUEST FOR ELECTRICAL INSPECTION `�
� � � � � �w 4 � � � Minnesota Board of Electricity �(�� �( �C�� � �
1821 University Avenue Suite S-128, Saint Paul, Minnesota 5�,5�1 4
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
De,�cribe -using th�k of the white copy'rf necessary - the �ork covered by this request:
I SERVICES I POWER SUPPLIES
Above 800 Am ere $75
CIRCUITS / FEEDERS
0 to 200 Am re $5
Above 200 Am re $10
ALARM, COMMUNICATION, REMOTE CANTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
3 to 12 Units @$50 Pe
Each AddiUonal Unit @
Retrofit an. $.25 per Fixture
Hour
Mi�e
Outdoor Liahtinu Standard
Supplemental Fee a $20
Transfortners u to 10 KVA a$10
Transformers over 10 KVA $ 20
Transformer I Power Su I for Si ns / Outline Li htin $5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dweliing Unit @$80
TOTALFEE
total fee is $201
I inspected the electrical installaGon desaibed herein on the dates staled:
ORDERED DISCONNECTED IF NOT COMPLETED WITF
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18564666
Date: Rough-in I�speation Required? ❑ Yes �J�O Inspeciion Other Than Rough-In: [� i�eady Now � Will Call
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� You must call the inspector when ready! J Date Ready:
I certify that I am tlie`�LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at: