P - 761111 7 8 7 0 4 9 4� REQUEST FOR ELECTRICAL INSPECTION
� � Minnesota Board of Electricity � �
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-500-627-3529 www.electricity.state.mtt.us
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Traffic Siunal Standard
FEEDERS Transformer I Power Su I for Si ns / Outline Li h6n $5
�0 re $5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
2U0 Am re $10 Includes the Senrice and/or Power Supply up to 500 Amperes, All
tt�AMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Tvdo Inspection Trips Each Dwelling Unit @$BO
CIRCUfTS OF LESS THAN 50 VOLTS Additional Ins cction Tri $20
� tem Qevice or Apparatus @$.50 Investlgative Fee
ADDITIONS TO THE GENERAL FEES Reinspection Fee @$20
�LY DWELLIPIGS PER UNI TOTAL FEE bQ, �iO
Uni� @$50 Per Unit (minimum total fee is $20)
1d�ltlonal Unit @$25 *H�sa�a voa wsrECroa us� ornv
OTHER ADDITIONAL FEES
9 R�trofit Ca? $.25 pe� FiXtufe I hereby ceitity that I inspected the electrical installaation described herein on the datav stat�:
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a�l kts�ectian @$.31 per Mile I �
f�STALLATION AAAAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 IIAONTHS
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��' Rough-in Inspectlon Requiredl ❑ Ye �] No Inspection Other Than Rough-In: �Ready Now � Will Call
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You must call the inspedor when ready! Date Ready:
l c�}r that I am the � UCENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at