P - 782591 /� REQUEST FOR ELECTRICAL INSPECTION
1� 4 4 7����F � Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
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D ADDITION O REPAIR Descnbe -usmg the back of ihe white copy rf necessary - the work covered by this request:
)MMUNICATION, REMOTE CONTROL
CIRCUITS OF LESS THAN 50 VOLTS
iystem Device w Apparatus � 5.50
3 to 12 Units � E50 Per
Each Additional Unit � ;
� Retrofit
Pivot Irti
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Traffic Si nal Standard $5 '
Su lemental Fee $2p
Transfwmers u to 10 KVA $10
Tra�sfortners over 10 KVA $ 20
Transtormer / Power Su I fw Si ns I Outline Li htin a5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Inciudes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
TOTAL FEE
(minimum total fee is $20) � �
THIS MFA FOR INSPECTpi USE ONLY
I hereby certfy tl�at i inspecOed the electrical installa6on described I�erein on the date.s staled:
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� Special Inspection � E.31 per Mile I I
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETEO WITHIN 12 MONTHS _`_
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Rough-in inspection Required? ❑ Yes 9�d �nspectip� p�her Than Rough-In: dy Now ❑ Will Call
You must call the inspeda when ready! / Date Ready:
NSED CONTRACTOR ❑COMPANY ❑ OWNER and hereby request inspection of 1he electricai wo�C at:
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