P - 76007REQUEST FOR ELECTRICAL INSPECTION
1����� 4 0 5� Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 T'fY/MRS 1-800-627-3529 www.edectrictly.state
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� GENERAL FEES Outdoor Lighting Standard @$1
SERVICES / P R SUPPLIES _ Traffic Sianal Standard lcD $5
0 to Z00 AmPere @ $5 �„ �- , - —
Above 200 Ampere @$90
!M, COMMUNICATION, REMOTE CONTROL
;UITS, CIRCUITS OF LESS THAN 50 VOLTS
3 to 12 Unfts (a� $50 Per Unft
Each Additional Unit @ $25
OTHER AD
Hour
ONE & TNO FAMILY DWELLINGS, EACH UNR
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dvrelling Unft @$80
total fee is
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I hereby certi(y U�at I Inspected the electrical ins�llabon d� hereln an fhe dates stated:
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�� / Rough-fn Inspecfion RequiredT �,Yes ❑ No Inspectlon Other Than Rough-In: ❑ Ready Now ❑WiII Call
��(��o `�' You must call the inapector when ready! Date Ready.
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I certify that I am the j$�LICENSED CONTRACTOR ❑ COMPANY ❑ OINNER and hereby request mspection � the el�trical work at
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�tor ucerree Number nnester Frecmaan or
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