P - 77243REQUEST FOR ELECTRICAL INSPECTION
1- 610 - 6 9 3� Minn@sota Bo!!rd of Electriaty
1621 University Avenue Suite S-128, Sairrt Paul, MinnesWa 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us
❑ NEW ❑ REMODEL ❑ ADDITION REPAIR Describe -using the badc of the white copy 'rf necessary - the work covered by this request:
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GENERAL FEES Outdoor liahtina St�dard � St
JICES / POWER
0 to 400 Amcere
ALARM, COMMUNICATION, REMOTE CONTROL, SI6
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparalus � E.50
ADDITIONS TO THE GENERAL FEES
2 Units � S50 Per Unit
Additional Unit � E25
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Paric Lofs =
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16L06932
I Transfamers up b 10 KVA � E10
� Tr�sfamers over 70 KVA (� E 20
Tr�siortner / Power SuDPIy for Sians I Outline Liphdna � a5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/a Power Supply up to 500 Amperes, All
Cir�uits and Two inspection Trips Exh Dwelting Unil @ j80
Reins tion Fee E20
TOTAL FEE
(minimum total fee is $20) ��l S�
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I hereby cerlly tl�at I i�pet0ed Ihe dectrical i�all�on described herein pn Me da9es sfated:
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'�V��/ Rough-in Inspection Required7 ❑ Yes �JO Inspedion Other Than Rouph-In: eady Now II Call
7 f y''� �js""' You must call the inspeclor when ready! pete Rmdy;
I certi(y lhat I am 1he C�CENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request nspection af 1he e�.fiical work at:
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