P - 78030REQUEST FOR ELECTRICAL INS�PjECTION
1��J 0.0 -191 �0 Minnesota Board of Electricity ✓ Qa?l�"7 �
1821 University Avenue Suite S-128, Saint P I Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627- .electriciry.state.mn.us
REMODEL ❑ ADDITION REPAIR Describe -using the back of the white cop ' ry- the work covered by lhis request:
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GENERAL FEES Outdoor Lighting Standard @$1 � 1
0 to 400 Am ere $25
401 to 800 Ampere @ $50
Above B00 Ampere @ $75
CIRCUITS / FEEDERS
.0 to 200 Ampere @ $5
� Above 200 Ampere @$10
ALARM, COMMUNICATION, REMOTE CONTROI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL
Each Additional
Unit
ADDITIONAL FEES
Transformers uo to 10
� Transfortner / Power Supply for Signs I Outline Lighting @$5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes lhe Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Fee
TOTAL FEE I
(minimum total fee is $20) p��% --�
iHIS AREA FOR INSPECTOR USE ONLY
that I inspected Me electrical installation described herein on the dates staled:
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15001910
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Request Dffie: Rough-in Inspection Required? ❑ Yes 7��AIQ Inspecfion Other Than Rough-In: �eady Now ❑ Will Call
�%�� �..�� You must call the inspector when ready! Date Ready:
I certiry that I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at: