P - 77691/� ❑ REQUEST FOR ELECTRICAL INSPECTION
1���i 3� d� 115 9 Minnesota Board of Electricity 2/�nc _��� c� -
1821 University Avenue Suite S-128, Saint`FauT, loliniiesota 1 °�
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
GENERALFEES
/ POWER
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
ADDITIONS TO THE GENERAL FEES
fIFAMILY DWELLINGS (PER UNIn
3 to 12 Units @ E50 Per Unit
Each Addi6on� Unit @ $25
OTHER ADDITIONAL FEES
Lighting Retrofit @ E.25 per Fi�ure
Center Pivot Irriaation Boom l� $40
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I I II (II
16411159
Trafic Si nal Standard $5
Su demental Fee $20
Transformers u to 10 KVA $10
Transformers over 10 KVA $ 20
Transformer / Power Su I for Si ns / OuUine Li hfin $5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes ihe Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additional Inspection Trips @ $20
investiaative Fee
TOTAL FEE I �Q
(minimum total fee is $20) �D "�'
iH15 MFA FOR INSPECiOR USE ONLv
I hereby cer6(y that I inspected the electrical insWla6on described herein on the dates stated:
�' �,/�-�=-�` �S �
Request Dete: Rough�n Inspection Required? ❑ Yes No Inspection Other Than Rough-In: Ready Now ❑ Will Call
,_ Q� You must call the inspecta when ready! pa�e Ready.
I cerMy that I am tlie �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of ihe electrical work aY.: