P - 75227REQUEST FOR ELECTRICAL INSPECTION
��� 7 9��� 4 � Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1 �00-627-3529 www.electricity.state.mn.us
Dasaibe -usir�g the tracic of the white copy ff n�ssary - the work covered by this requ�t: ,
o� 21%G G�y/e� F��i�J� � 1"°z cL1
GENERAL ES Outdoor Lightlng Standard @$1
SERVICES / POWER SUPPLIES _ � Traffic Sianal Standard a�. $5
' Above 200 Am ere $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCURS, CIRCUITS OF LESS THAN 50 VOLTS
Each Additlonal Und @ $25
OTHERADDRIONAL FEES
Li96tin9 Betrofit @ $25 per Fl�ture -
Cerrter Pivot Irtigatlon Boom $40
Manufactured Home Park Lots $25
Recreational Vehicle Park Sites $5
Se Bon U�s 'on $20
S Ins on �$30 per Hoiu
S Ins 'on @ $.31 per NIDe
S INSTALLATION MAY BE ORDERED DISCONNE
I I�I ��I � III � IIi I� �l ii rI II III Il OII 0� l�
19796549
Includes the Service and/or Power Suppty up to 500 Amperes, All
Ciraiits ami Tmo Inspection Trips Each Dwe�ing Unit @$80
Add'fional Inspection Trips @ $20
Irnestlaative Fee
. �.. �.0
(minimum total fee is
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bY cgtlfyfha! I inspe�ed the el�trical
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h�0atlon d�d hereinun fhedates sta�:
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) IF NOT COMPLETED WITHIN 12 NU
i�C'D�A°��t�E� �� �2�1t
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��' I Rough-in Ittspecdon Required9 B'4�es ❑ No I�pection Otlier Then Rough-In: � Ready Now �m Ca0
•,�/� 7 You must call the inspector when readyl Date Ready.
I c�rtdy thffi I am the 1...7�CfCENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request i�pection of the el�;trical work at
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