P - 78258REQUEST FOF� ELECTRICAL INSPECTION
1�� 4 7� 7 7 5 � 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
EVx Q EL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
� ' � GENERALFEES
SERVICES / POWER SUPPLIES
ALARM, COMMUNICATION, REMOTE CONTROI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
3 to 12 Units @$50 Per Unit
Each Addfional Unit @ $25
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Transformers u to 10 KVA $10
Transformers aver 10 KVA (d $ 20
Transfortner / Power Supply for Sions I Outline Lighting .$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 Unit @$80
Fee
Fee
(minimum total fee is $20) � s�� ��
.
iH15 MEA Fdt IISFECiIX2 USE pLY
I hereby teAify that I inspecfed the electrical installa6on described herein on the dates stated:
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OMPLETED WITHIN 12 MONTHS
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