P - 77235REQUEST �OR EL,�CTRICAL INSPECTION
1—�� o���F 7� Minnesota Boar�of Electr�ity
1821 University Avenue Suite S-128, Sairrt Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-600�27-3529 www.electricity.state.mn.us
❑ NFW �MODEL ❑ ADDITION ❑ REPAIR Descri -using the back of the white copy if necessary - the work cove2d by this request:
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GENERAL FEES Outdoor Li htin Standard $1
SERVICES / POWER SUPPLIES Traffic Si nal Standard 85
0 to 400 Am re $25 Su lemental Fee $20
401 to 800 Am re $50 Transfamers u to 10 KVA $10
Above 800 Am re $75 Transfortners over 10 KVA S 20
CIRCUITS / FEEDERS Transfortner I Power Supply for Signs I Outline Lighting (aD $5
AIARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or ratus $.50
ADDITIONS TO THE GENERAL FEES
OTHER ADDITIONAL FEES
Rehofit � 8.25 oer Fixture
Hour
IIIII IINI IIIII IIIlI IIIII IIIII II III IIIII �� II�
15709470
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Trvo Inspection Trips Each Dwelling Unit �$80
Additional Ins tion Tri s $20
Investi ative Fee
Reins tion Fee $20
TOTAL FEE
(minimum total fee is $20) ��i
THIS AREA FIXi INSPECiOR lISE qJLV
I hereby cer6y that I inspected the electric� installa6on descnbed herein on the dales sfated:
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E%PIREDIA&NDONED DATE
:CTED IF NOT COMPLETED WITHIN 12 MONTHS
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Request Date: Rough�n Inspeclion Required? s ❑ No Inspeqion Other Than Rough-In: ❑Ready N II Call
You must call the inspedor when ready! Date Ready:
I certify that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the elecficxl work at: