P - 78942n � REQUEST FOR ELECTRICAL INSPECTION
1��` 'J' 4`-* 1 8� Minnesota Board of Electricity -
1821 University Avenue S' e S-128, Saint Paul, Minnesota 55104
(651) 642-0800 ��ARS *800-627-3529 www.electricitystate.mn.us
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O,fJEW O REMODEL ❑ ADDITION ❑ REPAIR Describe -usiqg _ the white copy if necessary - the work covered by this request:
FEES
SERVICES / POWER SUPPLIES
0 to 400 Amcere (al $25
CIRCUITS I FEEDE
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aooaratus �$.50
OTHER ADDITIONAL FEES
LighGng Retrofit @ $.25 per Fixture
Center Pivot Irtiaation Boom (aD S40
Outdoor Lighting Standard
Traffic Sianal Standard (a�
i ranstormers over �u rcvn a� a zu
Transfortner / Power Supply for Signs / Outline Ligh6ng @ E5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes ihe Service andlor Power Supply up to 500 Amperes, All
Cirouits and Two Inspection Trips Each Dwelling Unit �$80
Additional Inspection Trips � $20
Investiaative Fee
(minimum total fee is $20) �
THIS AREA FOR INSPECiIXY t
I hereby certify Mat I inspected the electrical installaUon
:
on the dales sheted:
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Request Date: Roughin Inspection Required? ❑ Yes No Inspedion Other Than RougMn: dy Now 0 Wfll Call
��� � You must call the inspecta when ready! Date Ready:
I certify that I am the I�ICENSED CONTRACTOR ❑ COMPANY 0 OWNER and heieby request inspecfion of the �ectricxl work at: