P - 78362REQUEST FOR ELECTRICAL INSPECTION
1 4 8 5- 7 71 8❑ Minnesota Board of Electricity �
r 1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
EW ❑ REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
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I POWER SUPPLIES
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Apparatus @$.50
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
Retrofit
Boom
� Special Inspection @$.31 per Mile I
THIS INSTALLATION MAY BE ORDERED DISC(
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Transformers u to 10 KVA $10
Transformers over 10 KVA $ 20
Transformer I Power Supply for Signs I Outline Lighting @$5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Inctudes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$80
' TOTALFEE
(minimum total fee is $20) ZA �7
TNIS MEA FOR INSPECTpi USE QLY
I hereby certi(y that I inspeded the elec6ical insfalla6on described herein on the d�es s�led:
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Request Date: Rough�n Inspection Required? ❑ Yes ,p'ICo Inspedion Other Than Rough-In: ady Now � VYdI Call
9� � 9 r, p'j You musl wll the inspeclor when readyl Date Ready: Q' �� �� �
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I certify that I am the �CENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work ai: