P - 78453C (� REQUEST FOR ELECTRICAL INSPECTION
1� J� V- 4 7 9� Minnesota Board of Electricity -
- 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
s (651) 642-0800 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us
0 NEW ❑ REMODEL ❑ ADDITION REPAIR Describe -using the back of the white copy 'rf necessary - the vrork covered by this request:
GENERAL FEES Outdoor Lighting Standard $1
401 to 800 Am ere $50
Above 800 Ampere @ $75
CIRCUITS I FEEDERS
0 to 200 Ampere . $5
Above 200 Ampere @$10
ALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
3 to 12 Units �$50 Per Unit
Each Addi6onal Unit @ $25
OTHER ADDITIO
Liah6na Retrofit � 825 oer Fi�Aure
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1 5 3 0 4 7 9 3.
Transformers u to 10 KVA $10
Transformers over 10 KVA .$ 20
Transfortner I Power Supply for Signs I Outline Lighting �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$60
ivin�rrt
(minimum total fee is $20) � !
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I hereby certify Mat I inspechd the electrical instaAaOOn desaibed herein on tlre dales st�d:
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INS7RUCTONB ON BACK D� Y6GAW COpY � BO/U2p pF ELECTRICIT' CAPY
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Licm�se Number
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` E&00001A-74 8.1.2(q2