P - 78243/� REQUEST FOR ELECTRICAL INSPECTION
1-`t �,5 — 7 2 O ,� Minnesota Board of Electricity
� 1821 University Avenue Suite S-128, SaiM Paul, Minnesota 55104
(651) 642-0800 7lY/MRS 1-SOO�fi27-3529 www.electriciry.state.mn.us
❑ NEW MODEL ❑ ADDITION ❑ REPAIR Describe -using the back of e white copy ' necessary - the work covered by Mis request:
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GENERAL FEES Outdoor L' htin Staridard $1
SERVICES I POWER SUPPLIES Traffic Si nal Standard $5
0 to 400 Am re $25 Su lemental Fee 520
401 to 800 Am re $50 Transfortners u to 10 KVA $10
Above 800 Am e $75 Transformers over 10 KVA $ 20
CIR ITS I FEEDERS Transfortner I Power Su I for Si ns / Outline Li htin $5
0 to 2(!0 Am e S5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere $10 Includes ihe Service ar�dlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circui� and Two Inspection Trips Each Dwelling Unit @$60
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS AddiGonal Ins 6on Tri s $20
Each Svstem Device or Aooaratus �? $.50 Investiaative Fee
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ALLATION
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I certify that I am the
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TOTAL FEE I , j U
(minimum total fee is $20) � �
iM5 MEA FOit IIbPECiOR USE OrIY
I hereby cerGy that I inspec0ed the electrical installa6on described herein on tlie dales stated:
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Rough-in Inspection Required? es ❑ No Inspection Other Than Rough-In: OReady Now I Call
You must call the inspeclor when ready! Date Ready:
NSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the elecUical work at: