P - 76631REQUEST FOR ELECTRICAL INSPECTION �°'�
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2_ V 7�,� � g 4, � Minnesota Board of Electricity �-. �,
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104 �:
� (651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
Describe -using the ack�af the white copy if necessary - the work covered by this request: �� � ��� � S",pJ`yi C
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GENERAL FEES Outdoor Liqhtinq Standard (� $1
✓ICES / POWER SUPPLIES
0 to 400 Ampere @ $25
401 to 800 Amcere Cd $50
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
i Home Park Lots
Vehide Park Site:
Y BE
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Transfortners u to 10 KVA $10
Transformers over 10 KVA @$ 20
Transfortner / Power Supply for Signs I Outline Lighting @$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
TOTAL
total fee is'
that I inspected the elecUical installation described herein on the dates stated:
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IF NOT COMPLETED WITHIN 12 MONTHS ___ _�
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Date: Rou h-in Ins
g pection Required? ❑ Yes No Inspection Other Than Rough-In: ❑ Ready Now ill Call
��"V b You must call the inspector when ready! Date Ready:
I certify that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at