P - 78055'�- REQUEST FOR ELECTRICAL INSPECTION
1.�- 5 31-114 � Minnesota Board of Electriaty
�� 1821 University Avenue SuRe S-128, SaiM Paul, Minnesota 55104
(651)642-0800TTY/MRS1-800�27-3529 www.electricity.state.mn.us
❑ NEW �EMQpEL 0 ADDITION ❑ REPAIR Describe -using the back of ihe white copy ff necessary - the work covered by this request:
�C�v �51—��J--���d
GENERAL FEES Outdoor ' htin St�darcl $1
SERVICES / POWER SUPPLIES Trafic Sign� Standard (D E5
ALARM, COMMUNICATION, REMOTE CONTROI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Appaatus @ S•50
ADDITIONS TO THE �ENERAL
MULTIFAMILY DWELLINGS PER UNI _
3 to 12 Units @$50 Per Unit
OTHER ADDITI01
Retrofit � S25 oer Fixture
Su demental Fee $2(1
Transformers u to 10 KVA a$10
Transfortners over 10 KVA @$ 20
Transfortner I Power Su I for Si ns / OuUine Li htin $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit � S80
TOTAL FEE SU
(minimum total fee is $20) �Q --'��
iH15 ARE� Fpt WSPECiOR USE IXlY
I hereby certfy th� I inspeded the ek�ctrical instaYa9on described herein on the dates stated:
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Request Dete: Rough�n Inspectian Required? ❑ Ves [�o Inspecfion Other Than Rough-In: ❑Ready Now�'WNI Call
l�� ��(/.3 You must call the inspector when ready! Date Ready:
I certi(y that I am tlie �CfCENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at: