P - 78221REQUEST FOR ELECTRI�CAL INSPECTION
1� 4 7 5- 0 2 4❑4 Minnesota Board of ElecUiaty ��52% -
1821 University Avenue Suite S-128, Saint Paul, fiAinnesota 55104
" (651) 642-0800 TTY/MRS 1-800�27-3529 www.electricity.state.mn.us
❑ ADDITION ❑ REPAIR Describe -using the back M ihe white copy rf necessary - the work covered by this request:
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GENERAL FEES Outdoor Liahtina Standard (� St � .
)MMUNICATION, REMOTE CONTROL,
CIRCUITS OF LESS THAN 50 VOLTS
>vstem Device or Anoaratus � $.50
� Transformers up to 10 KVA @$10 Q
� Transfortners over 10 KVA �$ 20
Transformer / Power Supply for Siqns / Outline Lightino $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelting Unit @$80
Addi6onal Insoection Trios la? $20
Fee
Fee
1LTIFAMILY DWELLINGS PER UNIT —" TOTAL fEE ���^
3 to 12 units @$50 Per unit (minimum total fee is $20) �'T�
Each Additional Unit @$25 THis naEn Fac irucECroa usE owr
I hereby cer6y that I inspected tlie electrical installa6on described herein n
OTHER ADDITIONAL FEES ����
Li htin Rehofit $.25 er Fixture
Center Pivot Irti ation Boom $40 R0�"'" w'E
Manufactured Home Park Lots $25 � 2� G
Recrea6onal Vehicle Park Sites $5 F'"u "'�Ci10N ��E
Se arate Bondin Ins tion $20 � 2�--� i
S ial Ins U0f1 $� Bf HpUf Ex�nEOi�e+r+oo�vEO oarE
S ial Ins 6on $.31 r Mile
�IS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS ___
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1 4 7 5 0 2 4 4
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rceques[ uate: Rough-in Inspection Required? ,�Ves ❑ No Inspedion Other Than Rough-In: ❑Ready Now Will Call
11- 21- 0 3 you must call the inspector when ready! Date Ready:
I certify that I am the �LICENSED CONTRACTOR ❑ COMPANY u OWNER and hereby request inspection of tlie electrical work at: