P - 78461REQUEST FOR ELECTRICAL INSPECTION �
1— 5 31- 0 4 9� Minnesota Board of Electricily - ..
� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
�� (651)642-0800TTY/MRS1-800�27-3529www.electriciry.state.mn.us
❑ NEW REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of Ne white copy 'rf nflcessary - the work covered by this request:
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GENERAL FEES Outdoor Li htin St�dard $1 '
SERVICES I POWER SUPPLIES Trafic Si nal Standarcl $5
0 to 400 Am e$25 Su lement� Fce $20
401 to 800 Am re E50 Transfortners u to 10 KVA $10
Above 800 Am E75 Transfortners over 70 KVA E n1
CIRCUITS I FEEDERS Transformer / Power Su for Si ns I Outline Li hti ES
0 to 2(!0 Am re S5 P.� ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re$1 Includes ihe Service andlof Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unil � S80
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS Additional Insoection Trios � S20
ADDITIONS TO THE GENERAL
fIFAMILY DWELLINGS (PER UNIn
3 to 12 Units � S50 Per Unit
Each Addition� Unit � S25
IIIII Illll IIIII II II I li IIn111� nl� �� I�
15310493
TOTALFEE
(minimum total fee is $20) � ��
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I hereby certi(y U� I i�pecBed tlie elecbical i�ta9afion des�ibed I�erein on tlie dales s�ad:
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Request Date: Roughin Inspection Required? ❑ Yes �Fb Inspedion Other Than RaugMn: ❑Ready Nowg WiN Call
!��./�3 You must call the inspecta when ready! Date Ready.
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I certiy that I am 1he �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER ard hereby �equest inspection of 1he electrical work at: