P - 78751-* REQUEST FOR ELECTRICAL INSPECTION
�� 4 3 5-18 9� Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TlY/MRS 1-800�27-3529 www.electricity.state.mn.us
❑ NEW ❑ REMODEL ' DITION ❑ REPAIR Describe -using the back of the white copy 'rf necessary - the work covered by this request:
GENERAL
0 to 400 Ar
401 to 800
ALARM, COMMUNICATION, REMOTE CONTROL, SIG
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus �$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
� Special Inspection �$.31 per Mile
THIS INSTALLATION MAY BE ORDEREI
Outdoor Li h6n Standard $1
Traffic Si nal Standard $5
Su emental Fee $20
Transformers u to 10 KVA $10
Transformers over 10 KVA $ 20
Transformer I Power Su I for Si ns / OuUine L' htin $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes fhe Service and/or Power Supply up to 500 Amperes, All
Grcuits and Two Inspection Trips Each Dwelling Unit � S80
Additianal Ins tion Tri 320
InvesG ative Fee
Reins tion Fce $20
TOT/LL FEE
(minimum total fee is $20)
TMR NIFA FOR IlSPECTqi USE 0lLY
I hereby terAfy Mat I inSpecBed tlie electrical insfatla0on described heran on Ihe dales sf�d:
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Request Date: _ � Rpugh�n Inspecction Required7 , es ❑ No Inspection Other Than RougfNn: dy Now ❑ 1AM1 Call
You must call the inspector whe ready! pete Ready;
I certify that I am the �ENSED CONTRACTOR 0 COMPANY � OWNER and hereby request inspection of the electriral wak at: