P - 77717REQUEST FOR ELECTRICAL INSPECTION
1� O��t � 3 5 3� Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
C��� (651)642-OSOOTTY/MRS 1-800-627-3529 www.electricity.state.mn.us
Describe -using the back of the white copy if necessary - the work covered by this request:
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GENERAL FEES Outdoor Liahtina Standard C� $t
401 to 800 Am ere $50
Above 800 Am re $75
CIRCUITS I FEEDERS
0 to 200 Am re$5
Above 200 Am re $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
ADDITIONS TO THE GENERAL
fIFAMILY DWELLINGS (PER UNIT)
3 to 12 Units @$50 Per Unit
Each Additional Unit l� S25
Park Lots $
Park Sites
'on $2I
!�$30 aer Hour
THIS INSTALLATION MAY BE ORDERED
IIII II III � III II Ill II III IIlII II III II III �� I�
18L43537
� Transformers up to 10 KVA @$10
� Transformers over 10 KVA @$ 20
Transformer I Power Supply for Signs I Outline Lightin $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Fee
total fee is $20) I pC �
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1 hereby certify fhat I inspeded the elecUical insfallation described herein on ihe dates stated:
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IF NOT COMPLETED WITHIN 12 MONTHS
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" Rough-in Inspedion Required? ❑ Yes �NO Inspection Other Than Rough-In: � Ready Now �Will Call
�_ `� O� You must call the inspector when ready! Date Ready:
I ceRify that I am the �ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at