P - 78049REQUEST FOR ELECTRICAL INSPECTION
1� 516 �`t O� � Minnesota Board of ElecVicity -
1821 University Avenue Suite S-128, SaiM Paul, Minnes�a 55104
(651) OOT'fYlMRS1-800�27-3529 www.electricity.state.mn.us
NEW O REMODE ❑ ADDITION 0 REPAIR -using the back of the white copy 'rf necessary - the work covered by this request:
U � '
GENERAL FEES Outdoor Li h6n Standard $1
SERVICES I PO SUPPLIES Traffic Signal Standard �$5
ALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Exh Svstem Device or Apparatus (� $.50
iIFAMILY DWELLINGS (PEI
3 to 12 Units @$50 Per Unit
Each Additionai Unit @ $25
� Retrofit � $.25 per Fixture
Pivot Irtiaadon Boom � S4(
I I�I II ill II III II III II II I II I II II I II H ill N� I�
15�,64D64
Su lement� Fee EZO
Transfortners u to 10 KVA $10
Transformers over 10 KVA $ 20
Transfortner I Power Su for S' ns I Outline Li htin �5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspecfion Trips Each Dwelling Unit @$80
Additional Inscec6on Trips p $20
Irnes6 ative Fee
Reins Gon Fee $20
TOTAL FEE
(minimum total fee is $20)
rws �a� Fae iravEC,ai use
I hereby certify that I inspected the electric� insfall�on described herein on the dates sfated:
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rcequest uace: Roughin Inspection Required? LJ Yes � No Inspedion Other Than F2ough-In: �,Ready Now ❑ Will Call �
t/ �/� —b3 You musl call the inspector when ready! Date Ready.
I certiTy that I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at: