P - 78606REQUEST FOR ELECTRICAL INSPECTION
1 3 9 9- 9 0 6� Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
�� 5� (651) 642-0800 TTY/MRS 1-800�27-3529 www. electricity.state. mn. us
❑ NEW , 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 Lighting Standard @$1
401 to 800 Amper
Nwve 800 Amper
;UITS I FEEDERS
ALARM, COMMUNICATION, REMOTE CONTROI, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or aralus $.50
ADDITIONS TO THE GENERAL FEES
@ $25
Transformers u to 10 KVA $10
Transformers over 10 KVA .$ 20
Tr�sformer / Power Supply for Signs I OuUine Liqh6ng �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes ihe Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$80
TOTALFEE
(minimum total fee is $20)
THIS ARE� Fdi INSPECTOR USE plY
1 hereby cer6fy thffi I i�pecfed the electrical insfalla6on described herein on the da� s�Bed:
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Request Dale: Rough-in Inspectlon Required? Yes No Inspeciion Other Than Rough-In: �Ready No+v II Call
����3 You must call the i�spector when ready! Date Reedy:
I c�itiiy Uiat I am tlie :�CICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and he�eby request inspec6on of the electriral work at:
Job Site Address (Street �4 or Route No.) Ci1Y ��
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�P�oint E�Mre�y
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Ham Lake, MN 55304
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ntractor License Number Master EJectrician a Power L'anited Tednician
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