P - 78127REQUEST FOR ELECTRICAL INSPECTION
1^ 5� 9� O J V � Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651)642-0SOOTTY/MRS 7-800-627-3529 www.electricity.state.mn.us
O NEW REMODEL 0 A ITION ❑ REPAIR Describe -using the back of the white copy 'rf necessary - the work covered by this uest:
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GENERAL FEES Outdoor L' htin Standard $1
SERVICES I POWER SUPPLIES Traific S' n� Standard �5 �
0 to 400 Amcere � S25 Simnlrmnntal Faa G�i AN1 ., i � ,
CIRCUITS I FEEDERS
( 0 to 200 Am e$5
Above 200 Am re $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or ratus E.50
ADDITIONS TO THE GENERAL FEES
2 Units @ $50 Per Unit
Additional Unit @ $25
it Q $.25 per Fixture
rigation Boom @ $40
Home Park Lots � $
ehicle Park Sites � ;
Hour
ONE 6 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
TOTAL FEE I �j
(minimum total fee is $20) l�, ,� v
iMISMEAFIXtINSPECiptUSE V
I hereby certify that I inspecled tAe ekrtrical insGll�on described herein on the dates stated:
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� THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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Req Dffi • Rough�n Inspection Required? � Yes No Inspection Other Than Rough-In: ❑Ready Now Will Call
q�%� Q You must call the inspeqor when ready! Date Ready:
I t I am the ❑ LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of fhe electrical work at::