P - 77293REQUEST FOR ELECTRICAL INSPECTION
1� 7 3 2� O� J a Minnesota Board of Electriaty
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800�27-3529 www.e[ectricity.state.mn.us
0 NEW EMODEL ❑ ADDITION ❑ REPAIR Describe -u� ng the k of the wh�ite`��j if necessary - the work covered by this request:� /�
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GENERAI FEES Outdoor ' htin Standard S1
SERVICES / POWER SUPPLIES _ Tralfic Sianal Sfandard � E5
Tr�sfomiers u to 10 KVA $10
Transfortners over 10 KVA @ 3 20
Tr�sfamer / Power Supply for Signs I Outline Lighting $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Grcuits and Two Inspection Trips Each Dwelling Unit @ E80
I CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
ADDITIONS TO THE GENERAL FEES Reios tion Fce $20
ALY DWELLINGS PER UNI TOTAL FEE �
2 Units �$50 Per Unit (minimum total fee is $20) Q. �j
Additional Unit @ S25 *HSU� Fars rnaECraa us� aar
I hereby cer6fy tlW I inspecled the eleciical i�Yala9on desaibed haein on the da6as sUbd:
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�TED IF NOT COMPLETED WITHIN 12 MONTHS _ �
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neques[ e: Rough�n InspecUon Required? LJ Yes LJ No Inspeaion OMer Than Roughan: OReady Now ❑ YWI Call
�� � S You must call the inspectar when ready! Date Ready. .
I ceAi(y lhat I am Uie ICENSED CONTRACTOR 0 CObPANY ❑ OYIMER and hereby �equest inspe�iion of the electrical work at:
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