P - 78249/� REQUEST FOR ELECTRICAL INSPECTION
1��F ��- 6 3 5�1 Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
. (651) 642-0800 TfY/MRS 1-800�27-3529 www.electricity.state.mn.us
❑ NEW REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the work cove2d by t's re4uest:
� .
� G NERAL FEES Outdoor Liah6no Standard �$1
� Above 200 Ampere @$10
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus �$.50
ADDITIONS TO THE GENERAL F
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Additional Unit (� 825
OTHER
Ligh6ng Retrofit @ $.25 p
Center Pivot Irriaafion Ba
KVA
Transformers over 10 KVA $ 20
Transfortner / Power Supply for Signs / Outline Lightinu @$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unil @$80
Inves' ativeFee
Reins tion Fee $20
TOTALFEE
(minimum total fee is $20) ,
iH15 AREA FOR INSPECTCR USE OhtY
I hereb�at I inspected the elecfical installa6on described herein on the dates stated:
� Special inspection @$.31 per Mile I �
iIS INSTALLATION MAY BE ORDERED DISCONNECTE�
PLETED
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Request Date: Rough-in Inspection Required? ❑ Yes Inspection Other Than Rough-In: ❑Ready N Wfll Call
— You must call the inspectw when ready! Oate Ready:
I certi(y that I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at::