P - 78433REQUEST FOR ELECTRICAL INSPECTION
�� 41.� �� O�� Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
F (651) 642-0800 TTY/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 covered by this request:
FEES
� Above 200 Ampere �$10 �
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or atus $.50
ADDITIONS TO THE GENERAL FEES
Traffic Si nal Standard $5
Su lemental Fee $20
Transformers up to 10 KVA �$10
Transiormers over 10 KVA $ 20
Trar�sTortner / Power Su I for Si ns / OuUine L' htin $5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Txro Inspection Trips Each Dwelling Unit � a60
.LIIVUJ rcrc uni i TOTAL FEE c*�.w
$50 Pe� Unit (minimum total fee is $20) '� �
Unit �,l $25 Tws u� roa xarFCTars usE aar
I hereby cerdfy tl�ffi 1 inspected the instaAa6on described herein d�es staEed:
OTHERADDITIONALFEES �p0-E� %����12ssi't Y�'
$.25 er Fixture
iafion 800m � S40 R01GH1N w�
S ial Ins 'on 530 r Hour �D'"81tO0'E°
S iallns 'on $.31 Mile
iIS INSTAI,LATION MAY BE ORDERED DISCONMECTED IF NOT
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� u�e: /� Rough-in I�peclion Required? ❑ Yes �No inspet�ion Other Than Rough-In: ❑Ready N YWI Call
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I certity that I am tl�e �ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER ar�d heieby �equest inspaction � ihe elecbical work at:
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