P - 777521- 6 3 3' 2 7 4� REQUEST FOR ELEC� RICAL INSPECTION
Minnesota Board of Electrici
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
❑ ADDITION O REPAIR Desaibe -using the badc of the white copy rf necessary - the work co ered by this�/ uest:
'� �r�0/u 4� W i'r, �+� � C�G l
GENERAL FEES putdoor Liahtina Standard � S1
ALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aooaratus (� 5.50
� Trarisfortners up to 10 KVA @$10
� Transfortners over 10 KVA � S 20
Tr�sfortner I Power Supply for Signs I Outline Liphting � ES
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Suppiy up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$80
Fee
Fee
nrnm�u urrc�urv�� rcrt�mi IVIALhtt �1
3 to 12 Units �$50 Per Unit (minimum toTal fee is $20) Q� S `J
Each Additional Unit @ E25 *ws u� Foa ua�croa us� aar
� herebr ceNy mat � inspecka n�e el�'ca� rc�Aauon aesainea nerein on nK ea�es st�ea:
OTHER ADDITIONAL FEES J� ���j� / C'�
Lioh6na Retrofit � S25 oer Fixture C� V v� J/
eci� Ins on 530 r Hour
ecial Inspection @ 5.31 per Mile
INSTALLATION MAY BE ORDERED DISC
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16332744
Roughin Inspedion Required? ❑ Yes No Inspadion Other Than RougMn: ❑Ready Nav VYdI Call
5 Vou must call the inspeda when readyl Date Ready:
I ' U�at I am the ICENSED CONTRACTOR � COMPANY ❑ OWNER and heRby request inspection af the electrical wodc at: