P - 781931-5�5-�78�
0
GENERALFEES
SUPPLIES
0 to 400 Ai
401 to 800
REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of ElecVicity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651)642-080011Y/MRS 1-800�27-3529 www.electricity.state.mn.us
R Describe -using the bxk of the white copy 'rf necessary - the work covered by this request:
�or
Outdaor Linhtinq Standard C� S1
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or atus $.50
ADDITIONS TO THE GENERAL FEES
Z UniGs @ $50 Per Unit
Additional Unit @ E25
FEES
25 per Fixture
i Boom @ E4f
Park LoLs a
Park Sites �D'
>ve�on (� S2�
E30 cer Hour
Transformers u to 10 KVA $10
Transformers over 10 KVA .$ 20
Transfortner I Power SuDdY for Sipns I OuHine Liqhtina $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
tncludes tt�e Service andlor Power Supply up to 500 Amperes, All
Grcuits and Two Inspection Trips Each Dwelling Unit @$80
( TOTAL FE j I I, O' S V
minimum total fee is $20 n
iH15 AREA FOR INSPECipi USE OKY
I hereby cer6ry that I inspected the electrical installation described herein on the dates stated:
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'�e: Roughin Inspection Required? p No Inspection pther 7ha� Rqigh-In: ❑Ready Now I Call
� O You must call the inspedor when ready! pete Re�Y
t I am the I�LICENSED CONTRACTOR ❑ COA�ANY ❑ OWNER and hereby �equest inspection of the electrical work at:
__.. . __. . �a,�„�-,. o.,. �