P - 76712REQU�ST FOR ELECTRICAL INSPECTION
I �- 0 9 9� 4 2 6�.� 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 the white copy if necess/ary - the work covered by this request:
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GENERAL FEES Outdoor tiohtino Standard a(� S1
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Above 200 Am ere $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIG
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus $.50
ADDITIONS TO THE GENERAL FEES
3 to 72 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL
LighGng Retrofit @ $.25 per Fixture
Center Pivot Irriaation Boom (aD 840
Special Inspection $30 per Hour
S ial Inspection $.31 r Mile
THIS INSTALLATION MAY BE ORDERED DISCONN
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Traffic Sianal Standard
Transformers over 10 KVA $ 20
Transformer / Power Su I for Si ns I Outline Li htin $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT ,
includes the Service andlor Power Supply up to 500 Amperes, Ail
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additional Ins ion Tri s $20
Investiqative Fee
TOTAL FEE t$j . jU
(minimum total fee is $20)
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I hereby certiy that I inspected the electrical inslalla6on described herein on the dales stated:
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FINAL INSPECTION pq�
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WITHIN 12 MONTHS
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Date:1 _1 7-07 Rough-in Inspectlon Required? �.]Yes ❑No Inspection OtherThan Rough-In: ❑ Ready Now�]Will Call
You must call the inspector when ready! Date Ready:
I certify that I am the pil LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
�n57ftUCTIONS ON BACK OF YELLOW COPY
BOARD OF ELECTRICITY COPY
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