P - 77631[ �` REQUEST FOR ELECTRICAL INSPECTION
1�$��.i � V 4 8 � 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.state.mn.us
Describe -using the back of � e whi� py� ec� ess; - t e ork covered by t is request: .r� �� ,r�� D/� J/1
W r vr�i pl CJIJ �� T
GENERAL FEES Outdoor Liqhtinq Standard C� $1
0 to 400
Above 200 Am ere $10
ALARM, COMMUNICATION, REMOTE CAN ROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aooaratus C� $.50
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Liqhtinq Retrofit C�a $.25 cer Fi�Rure
Park Lots $
Park Sites
� ection $2i
$30 oer Hour
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Transformers u to 10 KVA $10
Transformers over 10 KVA $ 20
Transformer / Power Su I for Si ns / Outline L' htin $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 @$80
Additional ins ion Tri s $20
Investigative Fee
Reins ion Fee $20
5O� TOTAL FEE r �
(minimum total fee is $20) J �
THIS AREA FOR INSPECTOR USE ONLY
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I hereby certify that � speded the ele ' t installation described herein on ihe�Rs'StMB .
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=1H4LINSPECTI DATE
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INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT
12 MONTHS
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18356485 �2G�
Date�/ u��� Rough-in Inspection Required? %�Yes ❑ No Inspection Other Tnan Rough-In: ❑ Ready Now� Will Call
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� You must call the inspector when ready! Date Ready: /
I certify that I am th� LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work aT.