P - 78652` REQUEST FOR ELECTRICAL INSPECTION
*1 � 4. O���� 2 � Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
❑ NEW " EMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy 'rf necessary - the work covered by this request:
/ POWER SUPPLIES •
ALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Moaratus � 8.50
Outdoor Lighting Standard
Tra�c Sianal Standard l�;
Transformers over 10 KVA $ 20
Transfamer I Power Supply for Signs / OuUine Lightinu .$5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes ihe Service andlor Power Supply up to 500 Amperes, fUl
Circuits and Two Inspection Trips Each Dwelling Unit �$80
Fee
Fee
•��u��oo r�rt�i�n IUTALftt �
3 to 12 Units �$50 Pe� Unit (minimum total fee is $20) � , 5 Q
E2Ch Addi60n21 U�il �$25 r�ns u�n wre usrECrca usE orar
1 hereby certify that I inspected Ihe electrical insfallation described herein on the da� slated:
OTHER ADDITIONAL FEES � ��- ,� �
Li htin Retrofit $.25 r Fatu2
Center Pivot Irtiaation Boom � S40 R0U°'�+ arE
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�.ryueai vaie: ltough-in InspBCtipn Required? ❑ Yes I�JJo Inspection Other Than RcwgMn: dy Now ❑ Wfll Call
!"�-� �.� Yau must call the inspector when ready! Date R�dy
I certify that I am the �LICENSED CONTRACTOR 0 COMPANY ❑ OWNER ard hereby request mspection of the elechiql work at:
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