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❑NEW EMODEL ❑ADDITION ❑
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GENERALFEES
SERVICES / POWER SUPPLIES
0 M 400 Am e$25
401 ta 800 funoere � 550
REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electriaty
1821 University Avenue Suite S-128, Sairrt Paul, Minnesota 55104
(651) 642-0800 T'fY/MRS 1-800�27-3529 www.electriciry.state.mn.us
2 Describe -using the back M the white copy if necessary - the work covered by this request:
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Outdoor Liahtino Standard (aD Si
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aonaratus � 5.50
2 Units � S50 Per Unit
Additional Unit � $25
1ER ADDITIONAL FEES
25 per Fixture
i Boom @ 340
P�k Lots E25
Park Sitra m SS /
� Transfortners uD � 10 KVA ��10
J Transformers over 10 KVA �$ 20
Transformer / Power Supply tor Signs I Oulline Liqhtinq . E5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Ir�cludes the Service andlor Power Suppiy up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additionallnspection Trips $20
Investigafive Fee
Reinscec6on Fce (aD $20
(minimum total fee is $20) '� -
THISARfAFdtINSPECiOR p11V
I hereby cerOfy tlwt I inspected the elec6ical installation described herein on tl�e dates sta0ed:
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�Q�� �� Roughin Inspectlon Required7 ❑ Yes Irspedian Other Than Rough-In: �Ready Now I Call
�/'�U��%� You must call Me inspedor when ready! Date Ready.
I certify ttiat I am the �kICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby �equest inspection of the electrical work at: