P - 75985REQUEST FOR ELECTRICAL INSPECTION � '
� � � � � � � � � � Minnesota Board of Electricity
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTYlMRS 1-800-627-3529 www.eleetricity.state.mn.asr
D�cribe -using tlre back of the white co 'rf necessary - the work cove y this request:
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�= GENERJIL FEES Outdoor Ughtlng Standard $1
SERVICES / POWER SUPPUES Traffic Signal Standard @$5
0 to 400 Amaere C�a $25 � SuaplemeMal Fee (m $20
CIRCUITS OF LESS THAN 50 VOLTS
iystem Device or APparatus (a� $.50
ADDITIONS TO THE GENERAL FEES
3 to 12 Units @$50 Per Unft
Each Additional Unit C�D $25
Transformers u to 10 KVA $10
Transfortners over 10 KNA @$ 20
Transformer / Power Supply for Signs / Outiine Lighting Qa $5
ONE 8 TNO FRMILYDWELCtNGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Ampere.s, All
Ciraiits and Two I�pecUon Trips Each Dwelling Unit @$80
Additlomal Ira ection Trips (�D $20
Imestigative Fee
Reins�ecGon Fe.e � $20
TOTALFEE �/
(minimum total fee is $20) % �_�
I hereby cettl(y tlmt I tr�Cted the electrical i�VaHon desamed hereln on the dalav steted:
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4LLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 72 MONTHS
FOR OFFICE USE ONLY
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�' y�� Raugh-fn Inspedion Requhedl �es ❑ No I�pection Other Than Rough-In: ❑ Ready Now �1Vi➢ Cep I
���' V� You must cap the Inspector when readyl Date Ready: �`4
I c�rtify that I am the CENSED CONTRACTOR ❑ COMPANY � OWNER and hereby request ins�tion of the efectricai work at
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