P - 78083C /� REQUEST FOR ELECTRICAL INSPECTION
1— o' 6 6— g 7�F � Minnesota eoard of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
C1 �,�aZC.%� (651) 642-0800 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us
❑ NEW EMODEL ❑ ADDITION ❑ REPAIR Describe -using !he back of the white copy if necessary - the xrork covered by this request:
>1� ct,�.�sor� �G?sl ..1�'7b'�'S�
GENERAL FEES Outdoor Li htin Standard E1
SUPPLIES Traffic Sianal Standard O S5
0 to 400 Am re � b25
401 to 800 Ampere @ E50
Above 800 Ampere � $75
CIRCUITS / FEEDERS
0 to 2()0 Am e S5 .
Above 200 Ampere �$10
ALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Eaoh System Device or Appar�us �$.50
ADDiTIONS TO THE GENERAL I
MULTIFAMILY DWELLINGS PER UNI
3 to 12 UniLs �$50 Per Unit
Exh Additional Unit @ S25
OTHER ADDITIONAL FEES
Li hting Retrofit @ 5.25 per Fixtu�e
Center Pivot Irri ation Boom S40 ti
Manufactured Home Park Lols E25
Recreation� Vehide Paik Sites SS
arate Bondin Ins 6on ;20
Special InsDection 0 330 cer Fbur
IIII II III �) (II II III II II) II III II II) II III p� I�
15669740
� Transformer I Power SuDPIy for Signs I Outline LighGng (� $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit � E80
Reins tion Fee a20
TOTALFEE ry �
(minimum total fee is $20) �" �'
rns u�n Faa na�crat usE arar
I hereby certAy that I inspecled the ekctrical i�taAaOOn described herein on the dates sfaEed:
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ReQuest Date: Rough-in Inspection Required? ❑ Yes �No tnspedion O[her Than Rough-In: �Ready Now �Wfll Call
1—�`��' Vou must call the inspeda when ready! Date Ready:
I certify that I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical worlc at•: