P - 77110REQUEST FOR ELECTRICAL INSPECTION ���
�.,r��"����- 5 4 8� Minnesota Board of Electricity �- .�
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �`
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us ���
Describe -ugiqq the back of the white copy if necessary - the work covered by �is request:
I SERVICES / POWER SUPPLIES
Above 200 Am ere a$10
ALARM, COMMUNICATION, REMOTE CONTROL, SIG'
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Ap aratus $.50
ADDITIONS TO THE GENERAL FEES
Each Additional Unit
Lighting Retrofit @ $.25 per Fi�
Center Pivot Irtigation Boom C
Manufactured Home Park Lots
Su plemental Fee a $20
Transformers u to 10 KVA a$10
Transformers over 10 KVA $ 20
Transformer / Power Su I for Si ns / Outline Li htin $5
ONE 8 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
TOTALFEE
(minimum total fee is $20)
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I herebv certiry that I inspeded the electrical installation described herein on the dates stated:
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF
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I certify that I am the'�'
Job Site Street Address
Rough-in Inspection Required? ❑ Yes � Inspection Other Than Rough-In: �eady Now ❑ Will Call �
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�u must call the inspector when ready! Date Ready:
VSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the elecUical wo�C ai
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Fire No.
Please Provide Two (2) Phone
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Installation) ' Please Provide Tw (2) F
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