P - 78204REQUEST FOR ELECTRICAL INSPECTION
�� - 5 2 3- 7 6 4❑7 Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651)642-0800TTY/MRS 7-800-627-3529 www.electricity.state.mn.us
❑ NEW REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of fhe white copy if necessary - the work covered by this request:
� i n0 C�Y s
GENERAL FEES Outdoor Liahfina Standard (aD St
SERVICES /
tM, COMMUNICATION, REMOTE CONTROL, SIGNALING
UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.90
ADDITIONS TO THE GENERAL FEES
fIFAMILY DWELLINGS PER UNI
3 to 12 Units @$50 Per Unil
Each Additional Unit @ $25
FEES
Ligh6ng Rehofit @ E.25 per fixtuie
Center Pivot Irtiaation Boom � $4(
Traffic Signal Standard
Supplemental Fee @ $
Transformers up to 10 i
Transformers over 10 P
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes ihe Service andlor Power Supply up to 500 Amperes, All
CircuiGs and Two Inspec6on Trips Each Dwelling Unit @$BO
TOTAL FEE I ,�}�
(minimum total fee is $20) ��, J V
rws �a�n Foa irue�craR usE aar
I hereby ceN(y that I inspected the electrical installa6on described herein on the dates 5ta0ed:
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rcequesc ua�e: Rough-in Inspection Required? ❑ Yes ��lo Ins
�, � 1 ,, � pecUOn Other Than Rough-In: ❑Ready Now Will Call
� V You must call the inspector when ready! Date Ready:
I certify ihat I am ihe f�LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of ihe electrical work at::