P - 79282� REQUEST FOR ELECTRICAL INSPECTION
�� 7 7 3- 5 3 0 9❑ Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us
] ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
;{GEI. ENERGY S�.VER'S S�M?'CH
GENERAL FEES Outdoor Ligh6n Standard $1
'UES Traffic Sianal Standard (� $5 �
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
I Special Inspection � 5.31 per Mile �
�HIS INSTALLATION MAY BE ORDERED DISCOI
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I� II IN II IN II I II � III II��II II �I II �f I��
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Transformers u to 10 KVA $10
Transformers over 10 KVA $ 20
Transformer / Power SupDly for Signs I OuUine Lighting �$5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additional Inspection Trips @ $20
Investiaffiive Fee
(minimum total fee is $20) � $20.50
THIS MEA FOR INSPECTp1115E ONLv
I hereby ceNfy that I inspected the electrical installa6on descnbed f�ein on the dates stated:
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Request Date: Rough-in Inspection Required? ❑ Yes �lo Inspedion Other Than Rough-In: ❑l�ady Now O Nfill Call
d��� Yau must call the inspecla when ready! Date Ready.
I certify that I am the C�ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and he2by request inspection of Uie elecfical work at:
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