P - 78769REQUEST FOR ELECTRICAL INSPECTION
1 4 81 �� J O � Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651)642-0800 TlY/MRS 1-800-627-3529 www.electricity.state.mn.us
NEW ❑ REMODEL ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
GENERAL FE Outdoor Li htin Standard $1
SERVICES I POWER SUPPLIES Traffic Si nal Standard $5
0 to 400 Am re $25 Su lemental Fee $20
401 to 800 Am re E50 Transformers u to 10 KVA $10
Above 800 Am re$75 Transformers over 10 KVA $ 20
CIRCUITS / FEEDERS Transfortner I Power Su for Si ns I OuUine Li htin $5
0 to 200 Am re $5 ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re $10 Includes the Service andlor Power Supply up to 500 Amperes, All
AIARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Grcuits and Two Inspection Trips Each Dwelling Unit @$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins tion Tri $20
Exh S stem Device or A atus E.50 Inves � a6ve Fee
ADDITIONS TO THE �ENERAL FEES ReinsDection Fee �$20 � -
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
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TOTALFEE
(minimum total fee is $20)
TMS RREA Fp21N5PECi0R USE ONLV
I hweby cer6ry that I i instaNa6on desaibed
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��t �: Rough-in Inspection Required? ❑ No Inspectlon Other Than Rough-In: ❑Ready Now I Call
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I certify that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby �equest inspection of the electrical work at:
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