P - 78838[ REQUEST FOR ELECTRICAL INSPECTION
1�`# �i o° 6 9 0� Minnesota Board of Electricity
1821 University Avenue Suite S-128, SaiM Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
NEW ❑ REMODEL ❑ ADDITI N❑ REPAIR Describe -using the back of the white copy'rf necessary - the work covered by this request:
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GE ERAL FEES Outdoor Li h6n Standard $1
SERVICES I POWER SUPPLIES Traffic Si nal Standard $5
0 to 400 Am re $25 Su lemental Fce $20
401 to 600 Am re $50 Transformers u to 10 KVA $10
Above B00 Am re$75 Transformers over 10 KVA 5 20
CIRCUITS I FEEDERS Transfortner I Power Su I for S' ns I Outline ' htin $5
0 to 200 Am re $5 r 0 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re $10 Includes ihe Service ar�dlor Power Supply up to 500 Amp�es, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALIN� Circuits and Two Inspection Trips Exh Dwelling Unit @ S80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Addi6onal Inscection Trips �$20
Center Pivot Irtigation Boom @
Manufaclured Home Paric Lots
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(minimum total fee is $20) /�0'• S�
THS 1AFA FOR NSPECTORUSE QlY
I hereby certify tl�at 1 inspeCkE the electrical instalation described hdein on tlie dales sh6ed:
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Request Dafe: Rough-in Inspectiwi Required? ❑ Ves No Inspecdon Other Than RaigMn: dy Nw�r Q Will Cail
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I ce�tify that I am 1he�ENSED CONTRACTOR ❑ COIu�ANY ❑ OWNER and hereby �t inspection of tl�e electrical arwk at:
Job Site Adckess (Slreet Box. a Route No.) ( Cily Z�p Code
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