P - 780041-570-318 �
. I �71 �
EW ❑ REMODEL ❑ ADDITION ❑
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GENERALFEES
SERVICES I POWER SUPPLIES
0 to 400 Amcere [a2 E25
REQUEST FOR ELECTRICAL INSPECTION -� -
Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul. Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
R Describe -using the back of the white copy if necessary - the work covered by this request:
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ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Transformers u to 10 KVA $10
Transfortners over 10 KVA � 3 20
Trarisformer / Power Supply for Signs I Outline Liqhtinq @ ES
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes tt�e Senice andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspec6on Trips Each Dwelling Unit @$60
Additional Inspection Trips @ $20
Inves6aative Fee
I ItAMILY UWtLLINliS NtK UNI I I V IAL htt ^1 ��
3 to 12 Units @$50 Per Unit (minimum total fee is $20) d`�� �
Each Additional Unit � $25 rwsnaFnF«+irw�cT«+usEaxr
I hereby cerUfy thffi I inspected the electrical instaallation described herein on the daRes sta0ed:
OTHER ADDITIONAL FEES
Center Pivot Imga6on Boom �
ManufxWred Home Paik Lots
Recxeationai Vehicle Park Sit�
Hour
IIII �III IIIII IIIII IIIII (��I) IIIII II�I �� I�
15703L84
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�9�� �e� Roughin Inspection Required? LJ Yes -i'�Tb Inspedion Other Than Rough-In: ❑Ready Now��l Call
Ja��� "�� Vou must call the inspeUa when ready! Date Ready. 1a - 3� �Q�
I certify that I am the �ENSED CONTRACTOR ❑ COMPANY ❑ OWNER and heieby request inspection of the electrical work at: