P - 77154.• REQUEST FOR ELECTRICAL INSPECTION
�"� � 1�- 8 3 9� Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 7-800-627-3529 www.electriciry.state.mn.us
❑ NEW ❑ REMODEL 0 ADDITION PAIR Describe -using t�b�k of the white copy if necessary - the work covered by this request:
GENERAL FEES Outdoor htin Standard 51
I POWER SUPPLIES TraRc Si al Standard SS
10 Am re $25 Su lemental Fee $20
800 Am re $50 Transformers u to 10 KVA $10
800 Am re $75 Transformers over 10 KVA $ 20
' FEEDERS Transformer / Power Su I for Si ns / Outline Li htin $5
10 Am re $5 1C ONE & TWO FAMILY DWELLINGS, EACH UNIT
200 Am re $10 Includes ihe Service andlor Power Supply up to 500 Amperes, All
NdMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit �$BO
CIRCUITS OF LESS THAN 50 VOLTS Addi6onal Ins tion Tri $20
ivstem Device or Ao�aratus (� 5.50 Investiaative Fee
iIFAMILY DWELLINGS PER UNIT TOTAL FEE I 1�J'�
3 to t2 Units @ E50 Per Unit (minimum total fee is $20) �` ����
EeCh Addi60f181 Unll @ $25 rwsna�,F«+insaECtaauseanr
I hereby cer6ry thal I inspected the elec6ical installa6on described herein on tlie datat sfated:
OTHER ADDITIONAL FEES (, �+�—� ,_ ��^,��
Center Pivot Imgation Boom @
Manufaotured Home Park Lots
Recreational Vehicle Park Site:
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Request Date: Rough-in Inspection Required? ❑ Yes l� No Inspedio� Other Than Rough-In: ❑Ready Now`� Will Call
� 2�' �p ��` � You must call the inspeclor when ready! Date Ready:
I certity that I am the �LICENSED CONTRACTOR ❑ COMPANY u OWNER and hereby request inspection of the electrical work at::