P - 79197REQUEST FOR ELECTRICAL INSPECTION � ��
� r�� v- 516 � Minnesota Board of Electricity
1821 University Avenue Suite S-128, SaiM Paul, Minnesota 55104
� (651) 642-0800 TTYlMRS 1-800-627-3529 www.electriciry.state.mn.us
NEW ❑ REMODEL ❑ ADDIT��EL �PE��G���AYCKS� b��Cr�1 ite copy if necessary - ihe work covered by this request:
SERVICES ( POWER SUPPLIES
ALARM, COMMUNICATION, REMOTE CONTROI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
3 to 12 Units @$50 Per
Each Additional Unit @ I
Rehofit � $.25 oer Fixture
{II� �Il�� 8 �II I� i�I �� ��I � ��� II ��� II �I ��i ����
1 7 6 8 5 1 6 5
Traffic
Su demental Fee $20
Transformers u to 10 KVA $tU
Transformers over 10 KVA $ 20
Transformer / Power Su f for Si ns � Outline Li hGn $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unil @$80
Additional Inspection Trips $2�
Inves6qative Fee
TOTAL fEE 2d Sa
(minimum total fee is $20)
iH15 AREA FOp If15PECTOR USE CKY
I hereby certiry lhat I inspected tl�e electrical instsila6on deSCriDed herein on tice da�s sta[ed:
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Raquest Date: Rough-in Inspeclion Required? ❑ Yes ❑ Inspection Other Than Ragh-In: ❑ y Now 0 WNI Call
a���� `You must call the inspectw when ready! Date Ready:
I certify that I am the O�ICENSED CONTRACTOR ❑COMPANY ❑ OWNER and hereby request inspection of the electrical work at::
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