P - 75933REQUEST FOR ELECTRICAL INSPECTION
l� 9 6����� � Minnesota Board of Electricity I
1821 University Avenue Suite S-128, Saint Paul, Minnasota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.edectricity.state.mn.us
Descdbe -using the dc o4the white copy �if tn�essary - the work cover� by this request:
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GENERAL FEES Outdoor LiaMina Standard C�B $1
0 to 400
ALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
�� Each Svstem Device or Aaaaratus (� $.50
Each Add(tional Unit @
OTHE
Liahfir� Retrofit Cdi $2;
Transfomrers over 10 KVA $ 20
Transfortner / Power Supply far Signs / Outline Lightlng @$5
ONE & 1W0 FAMILY D4VELLINGS, EACH UNIT
Indud� the Service andlor Pawer Supply up to 500 Amperes, M
Circuits ar�d Two Inspection Trips Each DweUmg Unit @$80
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total fee is $201 � _ _
I hsrebv cmti(vthat I�ed tlre elechical h�lalladon desaibed fcerein on the dates sfe�: I
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ALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN
FOR Of�ICE USE OhU.Y
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�� Rough-In Inspectlon Rpufred? ❑ Yes �to Inspeclion Ofher Than Rough-In�Ready Now 0 WIU Ca0
��,��' /� `p You must call the Inspedcr when ready! Date Ready.
I c8rti(y that I am the�'LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
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