P - 77239REQUEST FOR ELECTRICAL INSPECTION
1-610-696 ❑5 �
Minnesota Board of �lectricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651 j 642-0800 TTY/MRS 1-800�27-3529 www.electricity.state.mn.us
�0 NEW� ❑ REMODEL ❑ ADDITION REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
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JICES I POWER SUPPLIES
0 to 400 Amcere � E25
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or ratus $.50
ADDITIONS TO THE GENERAL FEES
FEES
Transformers u to 10 KVA $10
Transformers over 10 KVA @ S 20
Transfortner I Power Supply for Signs / OuUine Lighting @$5
ONE 6 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Txro Inspection Trips Each Dwelling Unit @$80
Investi afive Fee
Reins tion Fee $20
TOTALFEE
(minimum total fee is $20) /' �
THIS MEA FOR It15PECTIXI USE pYY
I hereby certify Mat I inspected the ekttrical inshdll�on desaibed herein on the da�s staled:
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Request Rough-in �nspection Required? LJ Yes OIfJo Inspedion Oth� Than Rough-In: ,l�Ready Now ❑ Will Call
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You must call the inspector when ready! Date Ready:
I certify t I am the �j.ICENSED CONTRACTOR OCOMPANY 0 OWNER and hereby request inspection of the electrical work at: