P - 78248/�[ REQUEST FOR ELECTRICAL INSPECTION
1��F U�- 5 9� 5❑ Minnesota Board of Electricity
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
� NEW EMODEL ❑ ADDITIONDq REPAIR Describe -using th�,back M the white copy if necessary - the work c�vered by,;his request: �
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GENERAL FEES Outdoor ' htin Standard S1
$ERVICES I POWER SUPPLIES ,: ,, _ �,� _ Traffic Sianal Standard O $5 , . _�
ilul, COMMUNICATION, REMOTE CONTROL,
:UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL F
iIFAMILY DWELLINGS (PER UNin
3 to 12 Units �$50 Per Unit
Each Addfional UnR � E25
OTHER ADDITIONAL FEES
�h6ng Retrofit @ E.25 per Fixture
Center Pivot Irriaation Boom � Eb0
I�N ii IN II III I I II I II III II III II III II III �� I il�
1 4 5 1 5 9 8 5
ONE � TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service aridlor Power Supply up to 500 Amperes, All
Circuits and Two Inspec6on Tnps Each Dwelling Unit �$80
TOTALFEE
(minimum total fee is $20)
TMS ARE� FOR MbPECiOR USE OKY
I liereby certity Mat I inspected the electrical insfalla6on described herein on Uie da�s sm0ed:
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K�1� e: Rough-in Inspection Required? ❑ Yes ❑ No Inspedion Other Than Rough-In: OReady Now ❑ VVill Call
�`� ��y You must call the inspecla when ready! Date Ready:
I cefify tt�at I am the CENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspecfion of the electrical work at:
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