P - 78681�-75�-�2� �
❑ NEW 0 REMODEL ❑ ADDITION
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GENERALFEES
SERVICES / POWER SUPPLIES
0 to 400 Amoere � $25
REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.sta n.us
R Describe -using the back of the white copy if necessary - the work cove s request:
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�utdoor Liah6na SSandard (�a $1
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
E�h Svstem Device or ADDaratus �$.50
3 to 12 Units @$50 Per Unit
Each Addi6onal Unit � $25
Retrofit
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I IIiI II �I II I I I II I I I II II� II III II III II Nl ll ll l l l li!
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Su lemental Fee $20
Transformers up to 10 KVA �$10
Transfortners over 10 KVA $ 20
Transformer I Power Su for Si ns I Outline Li htin $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Tnps Each Dwelling Unit �$80
(minimum total fee is $20) � �((J "_
TtnS ANEA FOR IibPECiOR USE ONLv
I hereby certify Nat I inspected tAe electrical installabon OestxibeA herein on me Oates �a0ed:
OMPLETED WITHIN 12 Mf)V�HS ��
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Request Dete: Rough-in Inspection Required? .❑ Yes o InspeGion Other Than Rough-In: ady Now ❑ Wfll Ca�l
� You must call the inspector when ready! Date Ready: �— �—�j
I certity that I am the �CENSED CONTRACTOR ❑COMPANY ❑ OWNER and hereby request inspection of the electrical work at: