P - 79086c REQUEST FOR ELECTRICAL INSPECTION
1<� V� o- 3 7 8� Minnesota Board of Electricity -
1821 University Avenue Suite S-128, SaiM Paul, Minnesota 55104
, �� �5�..�. (651) 642-0800 TTY/MRS 1-800�27-3529 www.electriciry.state.mn.us
❑ NEW REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the xrork covered by this request:
o t� i - -1�'i - -1 S
GENERAL FEES Outdoor Li h6n Standard $1
SERVICES / POWER SUPPLIES Traffic Si nal Standard $5
0 to 400 Am re$25 Su lemental Fee $20
401 to 800 Amcere �$50 Transformers uo to 10 KVA � S10
iMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS OF LESS THAN 50 VOLTS
TO THE GENERAL FEES
3 to 12 Units �$50 Per Unit
Each Additio�al Unit @ $25
IIII II I�I II �I) II II) II III II II� II I�� �� III 11 � I�
16103780
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$80
Fee
(minimum total fee is $20) � fX��'�
iH6 MEA FOR INSPECTOR USE CfIY
1 hereby tertify tliffi I inspec�d the electrical installation described l�rein on the dates sf�d:
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'�� �: Rough-in Inspedion Required? ❑ Yes �'FJo Inspecxion Otlrer Than Rough-In: ❑Ready Now Wpl Call
�- aa "� \ Yau must call the inspec(or when ready! (� pa(e F�aady.
I ceAiy Ciat I am the 'GCENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of 1he electrical work at: