P - 77248REQUEST FOR ELECTRICAL INSPECTION
1� 610 � 91 ❑6 Minnesota Board of ElectrV'City
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
0 NEV� ❑ REMODEL ❑ ADDITION REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
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GENERAL FEES Outdoor Liahtina Standard � S1
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CIRCUITS OF LESS THAN 50 VOLTS
3 to 12 Units @$50 Per Unit
Each Additional Unil @ $25
OTHER ADDITI01
Lighting Retrofit @ $25 per Fixture
Center Pivot Irtigation Boom @ a4C
Manufactured Home Park LoYs � S
Recreational Vehicle Park Sites �'
Hour
IIII II IN II ill II III II i� II lil II lil II III �� I�
L6L06916
Transformers u to 10 KVA $10
Transfortners over 10 KVA �$ 20
Transiortner 1 Power Supply fw Signs I Outline Lightinq �$S
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
( TOTAL FE j I �J �
minimum total fee is $20
THIS AREA FOR INSPECTOR USE ONLY
I hereby cer6ly lhat I inspecled tAe electrical insiaqa6on desuibed herein on the dales stated:
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Rough�n InspeUion Required'? LJ Yes L�No Inspedion Other Than Rough-In: ❑Ready Now Will Call
vou must wll the inspecl« when ready! �\ Date Ready.
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ON BACI COPY
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BOARD OF ELECiRICRV COPV
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License Number
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E&00001A-14 8.1.2002