P - 75988�g REQUEST FOR ELECTRICAL INSPECTION �' °°
��� 2 4� � 4�� � Minnesota Board of Electricity
1821 University Avenue Suite 5128, Saint Paul, Minnesota 55104
(651) 642-OS00 T7Y/MRS 1-800-627-3529 www.electricity.state.mrr.us
Describe -using the barac�f hite copy 'rf necessary - the work covered by this r�uest: �
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GENERAL FEES Outdoor Liahtlna Standard a(�. $1
AIARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A��paraWs �$.50
ADDffIONS TO THE GENERAL I
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Unfts @$50 Per Unit
Each Additlonal Unft @ $25
OTHER ADDRIONAL FEES
Li htfig Retrofit @$25 per Fudure
Center Pivot Irtiaadon Boom id $40
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Transformers up to 10 KVA Q$10
Transformers over 10 KVA (a� $ 20
Includes the Service andlor Power Supply up to 500 Amper�, All
Circuits and Two Inspection Trips Each Dwelling Unit @$60
Add'fional Ins 'on Tri $20
Imesd ative Fee
Reins 'on Fee $20
TOTAL FEE �j �
(minimum total fee is $20) l —
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I hereby certlfy that I tlts electricel NstaVatlon descnbed Ireretn on tlre dat� slaffid:
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Fuvai.ou�cnou � � �oare
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IECTED_ IF NOT COMPLETED WITHIN 12 MONTHS
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You must call the inspedor when ready! Date Ready.
I ceitify that I am the 0 LICENSED CONTRACTOR ❑ COMPANY �OWNER arni hereby request inspection of the electrical work at
Job Site Street Addr�s City
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