P - 78132REQUEST FOR ELECTRICAL INSPECTION
1- 5 9�- 6 3 3� Minnesota Board of Electriaty
1821 University Avenue Suite S-128, Sairrt Pa�tl, Min�eso4a
(651) 642,P600 TTY/MRS 1-800-627-3529 www.electric��n.us .....'. .
❑ NEW O REMODEL ❑ ADDITION RERAIR nDescdbe -usina th k of ihe white conv'rf necessarv - the wat covered bv this reauest:
GENERALFEES
SERVICES / POWER SUPPLIES
0 to 400 Amcere � E25
CIRCUITS OF LESS THAN 50 VOLTS
3 M 12 UniLS @ S50 Per Unit
Each Addition� Unit � S25
OTHER ADDITIONAL FEES
Lighting Retrofit @ f.25 per Fixture
Center Pivot Irtiaation Boom � S40 A tl
Transfom�ers u to 10 KVA 510
TransTortners over 10 KVA � S 20
� Transfamer / Power SuDdY � Signs I Outline Lightinq �;5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes ihe Senice andJor Power Supply up to 500 Artiperes, PJI
Grcuits and Two Inspection Trips Exh Dwellirg Unit � f80
Additional Inspection Trips � S20
7 Investgative Fce
( TOTAL FE; I �, � � I
minimum total fee is $20
rws u� wa rs�crop usE aar
I hereby cer6ty Ihat I inspec0ed the dectrical insfalla6on daaibed herein on the d�s staEed:
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� TFi151N5TALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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�Q Roughin Inspedion Required? ❑ Yes InspeGion Other Mn: ❑ NNI Call
Vou must wll the inspeUOr when ready! oare �eay:
I ceAiry that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby uest iispection of the electrical work at:
Jab Site Address ( te ) ity r�
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