P - 77287REQUEST FOR ELECTRICAL INSPECTION
1— 7 3 I�� 1 8 � Minnesota Board of Electriaty -
1821 University Avenue SuRe S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TfY/MRS 1-800�27-3529 www.electricity.state.mn.us
❑ N W ❑ EMODEL ❑ ADDITION REPAIR Describe -using the back of tl�e white copy ff necessary - the work covered by this request:
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/ GENERALFEES
SERVICES / POWER SUPPLIES
ALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
� Each Svstem Device or Aouaratus � 5.50
2 Units @ $50 Per Unit
Addi6onal Unit @ E25
�pecial Inspection @ $30 per Hour
lpecial Inspection @ S•31 per Mile
i INSTALLATION MAY BE ORI
II�I I�I�� Illll�ill!II!! IIIII IIIII IIIII �� I�
17379181
Tr�sfortners u to 10 KVA E70
Transfonners over 10 KVA $ 20
Transformer / Power Su I for Si ns I Outline Li htin a5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes ihe Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$60
Additional Ins tion Tri s $20
Investi ative Fee
Reins tion Fee $20
TOTALfEE
(minimum total fee is $20) , �
iN15 ARFA FOR MlSPECTpi USE p1Y
I hereby cerdy tha41 inspec0ed the electrical insfaN�on described herein on the d�s sf�d:
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�e� Rough-in Inspection Required? Ll Yes �No Ins l�N
pedion Other Than Ragh-In: ❑Ready Now I Call
��/ �,�� You must call tlie inspeUa when ready! Date Ready. .
I ceAiy that I am the �.LICENSED CONTRACTOR OCOIu�ANY ❑ ONINER and hereby request �spection of the electrical worlc at:
Job site nddress (sveet, eo�c « Ra,te No.) Citr // Zip code
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