P - 76089REQUEST FOR ELECTRICAL INSPECTION
2 � � o � � � � � � Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
_ (651) 642-0800 TTY/MRS 1-800-627-3529 www.edectricity.state.mn.us
D�cribe -using the tr�:irof the white copy ff necagsary - th cm{�erai by this request:
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GENERAL FEES Outdoor Liahtina Standard Ca� $1
0 to 400
iM, GOMMUNICATION, REMOTE CONTROL, SIGNALING
:UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Devic� w AppareWs @$.50
ADDITIONS TO THE GENERAL FEES
TIFAMILY DWELLINGS (PER UNI'�
3 to 12 UniGs (�il $50 Per Unit
sa�
Transformers ov�r 10 KVA $ 20
Transformer I Power Supply for Signs / OuUirre Lighting @$5
ONE & 1W0 FAMILY'DWELLINGS, EACH UNIT
Includ�s the Service and/or Power Suppty up to 500 Amperes, All
Circuits a� Two Ins�on Trips Each Darel�mg Unit @$80
TOTAL
total fee is ;
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I Irereby certty thet I inspeded the electrical i�0ation des�d� orVfFre datea�
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INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12
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I certify that I am
Job Site Street Ad
Com�nY
Rough-in Inspedion R�uired? y�.`Lea ❑ Na Inspedion Ofher Than Rough-In: � Ready Now �bV'�I Ca�
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You must call the inspedor when readyl Date Ready.
NSED CONFRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the etectricaf work at
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nnaster eiectrician or
Licerroe Number
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