P - 76248REQUEST FOR ELECTRICAL INSPECTION � �`
2-1�� °� 9� � �linnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
� ' O , (651) 642-0500 T1Y/MRS 1-800-627-3529 www.eleciriciry.state.mn.us '. � ' '�
D�cn'be -using e back of the white copy'rf necessary - the work covered b this request:
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GENERAL FEES Outdoor Liahtina Standard (a� $7
I SERVICES / POWER SUPPLIES
Above 200 Ampe�Q$10 �
�lui, COMMUNICATION, REMOTE CONTROL, SIG
;UITS, CIRCURS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDRIONS TO THE GENERAL FEES
iIFAMILY DWELLINGS (PER UNIn
3 to 12 Units (iD. $50 Per UnK
Manufacturai Home
INSTALLATION MAY BE ORDERED
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TransFortners wer 10 KVA $ 2(1
Transfortner / Poarer Su for Sf ns / Outline Li htin $5
ONE & TWO FAMILY DWELUNGS, EACH UNIT
Includes the Service andlor Power Supply up ro 500 Amperes, Au
Circuits and Twro Inspection Trips Each Dweuing Unit @$80
AddiGonal Ins 'on Tri $ZO
Investi ative Fee
Reins 'on F� $20
TOTALFEE
(minimum total fee is $20) Q
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I hereby certify that I faspeded Ute efectrical instellatlon desa�ed here6� on ihe detes s�ed:
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I cefify that I am the CENSED CONTRACTOR ❑ COMPANY ❑ OWNER artd hereby request inspection of the electrical work at
Job Site Street Address 1 - �y
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