P - 78021REQUEST FOR ELECTRICAL INSPECTION
'I � C/j /� _� Q � � Minnesoha Board of Electriaty
�t J�t �r v 1821 University Avenue Suite S-128, Sairrt Paul, Minnesota 55104
t � (651) 642-0800 TTY/MRS 1-800�527-3529 www.electriciry.state.mn.us
O NEW EMODEL ❑ ADDIT�� 0 REPAIR Describe -using the back the whfte copy rf necessary - the work covered by this request:
C(� �� - �
GENERAL FEES Outdoor ' htin Standard $1
SERVICES I POWER SUPPLIES Traffic Si�nal Standard � E5
ALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus �$.50
ADDITIONS TO THE GENERAL I
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units � E50 Per Unit
Each Additionai Unit � $25
OTHER ADDITIONAL FEES
li htin Retrofit 3.25 er Fixture
Center Pivot Irti ation Boom S40
Manufactured Home Park Lots $25
Recreational Vehicle Park Sites ES
arate Bondin Ins tion =20
Scecial Inscection � E30 oer Hour
INI IINI ulll IIIII Ilill I�III IIIII IIIII �� I�
15446818
Su lemental Fee E2(1
Transfortners u to 10 KVA 310
Transformers over 10 KVA $ 20
Tr�sfortner I Power Su far S' ns I Outline L' htin =5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspec6on Trips Exh Dwelling Unit � S80
Additionaf Inspection Trips @ E20
Investiaative Fee
i�in�rte `�
(minimum total fee is $20) � , sV
THIS �REA Fdi kEPECTdt USE p1Y
I hereby cerGry tlwl I inspected the electrical insfallation desaibed herein on the dafes staled:
VYITHIN 12
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��� �e: Rough-in Inspedion Required? ❑ Yes �Ao Inspec6on Ofher Th� Rqglr�n: �Ready Now VYNI Call
`Z',,. `5` d3 You must c�l the inspedw when ready! pate Ready;
I certiy tliat I am tl►e �LICENSED CONTRACTOR DCOIu�ANY ❑ OWNER and heieby request inspection of the electrical xrork at: