P - 77027REQUEST FOR ELECTRI�L I�SP �� g.�
1�- 713 - 2 0 9� Minnesota Board of Electriaty a� �;,�
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651)642-0800'ITY/MRS 1-800�27-3529 www.electriciry.state.mn.us
❑ NEW ❑ REMOD O ADDITIO�" REPAIR ribe -using the bxk of the white copy 'rf necessary - the woric covered by this request:
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GENERAL FEES Outdoor Ughting St�dard �$1
CIRCUITS OF LESS THAN 50 VOLTS
3 to 12 Units � 550 Per UnR
Each Additional UnR @ E25
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Transfortners u � 10 KVA $10
Transfionr�ers over t0 KVA (�D_ E 20
Transformer I Power Supply for Signs / Outline Ligh6ng � E5
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
TOTALFEE I �
(minimum total fee is $20) lp�
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I hueby cerEy tliat I inspecled tlie electrical i�laYOn described I�rein on tlie da6es sf�ed:
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Request Date: Rougtrin Ir�spection Required? ❑ Yes ❑ No Inspection Other Than RaugMn: ❑Ready Now I Call
°a(p -Q � You must call tAe inspecta wh� ready! pate Ready: .
I certify that I am 1he ICENSED CONTRACTOR 0 COMPANY ❑ OWNER and hereby �equest nspecfion of the elecUical work at:
Job Sioe Address ( a No.) City Zip Cade
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Please Provide Two (2) Phone Mxnber(s) Niduding f
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an,P�Y or ONrt�r Perf«,rring InstaMatl�a,> ,.�-
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tor� CaDPa�Y or Owner Perfortnin9lrufallation)
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n�ester �ectriaen a Power �imitetl Tednidan
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