P - 78960REQVEST FOR ELECTRICAL INSPECTION
1'� p U C7 - 2 2 4❑9 Minnesota Board of Electricity -
-� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
�(,. I Qf �� (651) 642-0800 TlY/MRS 1-800-627-3529 www.electricity.state.mn.us
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❑ NEW EMODEL ❑ ADDIT N❑ REPAIR Describe -using the b of the white copy if necessary - the work covered by this request
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SERVICES / POWER SUPPLIES
0 to 400 Amcere lal S25
ALARM, COMMUNICATION, REM�TE CONTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each SYStem Device or ADDaratus C� $.50
3 to 12 Units @$50 Per Unit
Each Addifional Unit @ $25
Center
Supplemental Fee @ $20
Transformers up to 10 KVA @$10
Transformers over 10 KVA (�a $ 20
� Transformer / Power Supply fa Signs / Outline Lighting �$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 Unit @$60
(minimum total fee is $20� � � 0�
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1 hereby cerE(y that I inspec0ed the electrical instalfation desctibed herein on the da�s sfa0ed:
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K est uate: Rough-in InspecGon Required? LJ Yes f�NO Inspectlon Other Than RougMn: UReady Now �[Witl Call
- a�•�� You must call the inspecla when ready! Date Ready:
I certiry that I am the ENSED CONTRACTOR ❑ COMPANY Q OWNER and hereby request irispection of tt►e elechical v�ork at: