P - 77698i
$ REQUEST FOR ELECTRIC,p►L INSPECTION
1� 6 41-110 � Minnesota Board of Eiectricity �1 �OS— jj�a�
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 5510�
(651) 642-0800 TTY/MRS 1-800�627-3529 www.electriciry.state.mn.us
O NEW ❑ REMODEL�� ION �EPN �D�n'be -usi�the back of tl�e white copy 'rf necessary - tlie�� ered by this request:
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GENERAL FEES Outdoor ' htin Standard $1
SERVICES I POWER SUPPLIES n TraRc Sianal Standard � i5
to 400 Am re bz5 i Su mental Fee S20
401 to 600 Am re $50 Transfortners u to 10 KVA 310
Above 800 Am re $75 Transformers over 10 KVA $ 20
CIRCUITS I FEEDERS Tr�sfortner I Power Su for Si ns I Outline Li htin E5
0 to 200 Am ES ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am S10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Cirouits and Two Inspec6on Trips Exh Dwelling Unit @$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Addi6onal Ins tion Tri s $20
Each System Device or Apparatus @ E.50 Investiaative Fee
71L1 UYYCLLIIVUJ YGKUIYII IUTALhtt
2 Units @$50 Per Unit (minimum total fee is $20) %�
Addi60n� Unit �$25 TM�S ARFA FOR N6PECTp3 USE OIIY
I hereby cer4ty tl� I inspetBed the elecbical iretaYaion described herein on the dates sfa0ed:
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INI� II (I) II III II II� IIIII II�I� IIII) IIIII II� I�
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rcoques[ ua[e: Hp�gh�n Inspection Required? LJ Yes C�o irxpeCUon Ofher Than RougMn: L�ieady Now ❑ WNI Call
q���w + �� You must call the inspector when ready! Date Ready.
I ceAiy that I am the �ICENSED CONTRACTOR ❑ CONPANY ❑ OWNER and hereby r¢quest �spection of the electrical work at: