P - 78715REQUEST FOR ELECTRICAL INSPECTION �
� � � [ � � � � O � Minnesota Board of Electricity - :
J 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651)642-0800T'fY/MRS 1-800-627-3529 www.electriciry.state.mn.us
� NEW ❑ REMODEL 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 htin Standard $1
SERVICES / POWER SUPPLIES Traffic Si nal Standard $5
0 to 400 Am e$25 Su lemental Fee $20
401 to 600 Am re $50 7ransformers u to 10 KVA $10
Above 800 Am ere $75 Transformers over 10 KVA $ 20
CIRCUITS I FEEDERS Transformer I Power Su for Si ns I OuUine Li htin $5
0 to 200 Am re $5 / ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 2(10 Am e$10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit @$60
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Addi6onal Ins tion T� s $20
DDITIONS TO THE GENERAL FEES Reins Uon ree bzu
IELLINGS PER UNI TOTAL FEE �
@ S50 Per Unit (minimum total fee is $20)
181 Unif @ $25 �wsnaewcoaxsvecTanusEaar �
I hereby certity that I inspected the elecbical i�stalla6on described herein on tl�e dates sfa�d:
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Request Date: Rough-in Inspection Required? �Yes ❑ No Inspectlon Other Than Rough-In: ❑Ready Now [�Will Call
�� —O ? You must call the inspector when ready! Date Ready.
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I certify ihat I am the �ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at: