P - 78250REQUEST FOR ELECTRICAL INSPECTION
1— 4, � 8� 8 4 2 � Minnesota Board of Electricity -
. 1821 University Ave�ue Suite S-128, Saint Paul, Minnesota 55104
(651)642-0800TTY/MRS1-800�27-3529 www.electriciry.state.mn.us
❑ NEW MODEL �DJITION ❑ REPAIR Describe -using the back of the white copy 'rf necessary - the work covered by this request:
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tM, COMMUNICATION, REMOTE CONTROI
:UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus 5.50
ADDITIONS TO THE �ENERAL
fIFAMILY DWELLINGS (PER UNIn
3 to 12 Units �$50 Per Unit
Each Addifional Unit � $25
OTHER ADDITIONAL FEE;
Lighting Retrofit @ $.25 per Fixture
Center Pivot Irtiaation Boom � 840
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Su lemental Fee @ $20 -.���-�-`' " ij
Transformers u to 10 KVA $10 �'�
Transfortners over 10 KVA $ 20
Transiortner / Power Su I for Si ns / OuUir�e Li h6n a5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Exh Dwelling Unit @$80
Additional Inspection Trips � $20
Investiga6ve Fee
Reinscection Fee � S20 _
TOTAL FEE �' (J
_ (minimum total fee is $20) � -�—
TIXS MEA FIXt INSPECiOR USE OI�aY
I hereby cer6fy thffi I inspected the ek�ctrical insialla6on described herein on tlie dffies sta�d:
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R uest Date: •, Rpugh-in Inspedion Required? ❑ No Inspection Other Than Rough-In: dy Now ❑ Will Call
�� 0 y You must call the inspeclor when ready! Date Ready:
I cer6fy ihat I am the �ICENSED CONTRACTOR OCOMPANY ❑ OWNER and hereby request inspection of the elecUical work at:
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