P - 75917REQUEST FOR ELECTRICAL INSPECTION � � '
1� 9 3 6- 4 5 5� Minnesota Board of Electricity k,� �
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
`'- (651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
Desaik - 9 the1 �of the whfte copy if necessary - the�"�°rk covered by this re,quest:
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GENERAL FEES Outdoor Li htin Standard @$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard Qa $5
0 to 400 Amoere C� $25 SuonlemeMal Fee na �20
)MMUNICATION, REMOTE CONTROL,
CIRCURS OF LESS THAN 50 VOLTS
iYStem Device or Aoaaratus GD $.50
B�m
Manufactured
over
Indudes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspecfion Trips Each DweOing Unit @$BO
� Reinspection Fee @ $20
TOTAI
(minimum total fee is
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THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPL.E�ED WITH
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I�' j� /�� Rough-in Inspection RequiredT ❑ Yes 'O� No Inspection Other Than Rough-In: ❑ Ready Now ❑ Will Call
tY�You must call the irrepedor when readyl Da6e Ready.
I certify that I am the,�1 UCENSED GONTRACTOR ❑ COMPAIVY ❑ OWNER and hereby request inspection of the electrical work at
Job Site Street Addr�s Cgy
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OtmedOccupent Neme �/ Please Provfde Two (2) Phone Numbers IrtGudhig Area Code
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IN9TRUC710NS ON B CK OF YELLOW COPY
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BOARD OF ELECTRICIIY CAPV
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Li�n� Number
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hona Numbers Induding Area Code
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