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❑ NEW EMODEL ❑ ADDITION 0 REf
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GENERALFEES
SERVICES I POWER SUPPLIES
0 to 400 Amcere � $25
0 to 200 Am ere $5
Above 200 Ampere @$1
ALARM, COMMUNICATION, REMOTE CONTROI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
3 to 12 Units @$50 Per Unit
Exh Additional Unit @ $25
FEES
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17004672
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I cerMy that I am the
REQUEST FOR ELECTRICAL INSPECTION
Nfinnesota Saard of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTYlMRS 1-800-627-3529 www.electricity.state.mn.us
2 Describe -using the back of the white copy if necessary - the work covered by this request:
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Traffic Si nal St2ndard $5
Su lementai Fee $20
Transformers u to 10 KVA $10
Transformers over 10 KVA $ 20
Transformer / Power Su I for Si ns / OuUine Li htin $5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes ihe Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additional Ins tion Tri $20 �
Investi ative Fee
Reins tion Fee $2Q
TOTAL FEE V
(minimum total fee is $20) p�0 .
iHiS ARFA FOR INSPECiIXt u5E p1Y
I hereby ce. ' that mspected the electrical insta�la6 described herein on Me dates stated:
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Rough-in Inspecyion Required7 ❑ yes hispeGion p�hr,y Than Rough-In: ❑Ready Now p�y��
You must call the ins�ctor when ready! Date Read .
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NSED CONTRACTOR OCOMPANY n numiFa ,.,a �,..,.�.. __.._.. _ .. _ _