P - 78343REQUEST FOR ELECTRICAL INSPECTION
1��� V-� 91 ❑9 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 if necessary - the work covered by this request:
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GENERAL FEES Outdoor Li hfin Standard 1
SERVICES I POWER SUPPLIES Traffic Si nal Standard $5
0 to 400 Am re $25 Su lemental Fee $20
401 to B00 Am re $50 Transformers u to 10 KVA $10
Above 800 Am re $75 Transformers over 10 KVA $ 20
CIRCUITS I FEEDERS Transformer I Power Su I for Si ns / Outline Li htin $5
0 to 200 Am re $5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re $10 Includes the Service and/or Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit @$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins tion Tri s $20
Each S stem Device or A aratus $.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins 6on Fee $20
MULTIFAMILY DWELLINGS PER UNIT TOTAL FEE �O1 �
3 to 12 Units @$50 Per Unit (minimum total fee is $20)
EachAddiGonalUnit@$25 TNisuu�ForsnarEC*oausEaav �
I hereby certify thffi I inspected ihe electrical insWla6on described hwein on Uie dates sfahed:
Retrofit � 5.25 cer Fixture
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Request te: Rough-in Inspection Required? es ❑ P10 Inspec[ion Other Than Rough-In: �Ready Now SI 1Nfll Call
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� 5`�3 You must call the inspector when ready! Date Ready:
J certify � m tl�e �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby iequest inspection of the electrical wodc at:
INS7RUC.dN8 ON BACK OF YELLOW COPY eon� oF etEC��c�Tr cvPr =_-•,•,••• �••- �- -... _..._.