P - 76142REQUEST FOR ELECTRICAL INSPECTION �°
1���F �� 5 5 6� Minnesota Board of Electricity
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
(651) 642-0800 T'fY/MRS 1-800-627-3529 www.electricity.state.mn.us
Describe -using the the white popq��ary - the wo ered by� �
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GENERAL FEES Outdoor Lightin Standard @$1
S RVICES / POWER SUPPLIES Traffic Signal Standard (a� $5
0 to 400 Am re@$25 °�'""^t Supplemental Fee @$20
401 to 800 Am re $50 .� Transformers u to 10 KVA $10
Above 800 Ampere (�D $75 Transformers over 10 KVA Ca9 $ 20
' Above 200 Am ere / %�
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aooaratus C� $.50
Pfvot Irzipation Boom
Includes the Service arb/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Addfional Ins 'on T ' $ZO
Investigetive Fee
Reins on Fe.e $20
TOTAL FEE
(minimum total fee is $20)
TIdS ARE� FOR PISPEC70R f Ig OALLV
I hereby ceAify that I inspeded the electrical mstallatlnn described herein on ffie da0es stated:
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INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS.
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I certify that I am 1
Rough-in Inspecdon R�uired? ❑ Yes� Inspedion Other Than Rough-In: ❑ Ready Novrj�901�Call
You must call the inspector when readyl Date Ready:
�dSED COIdTRACTOR „❑�EOMP,�NY_ p OWNER and hereby request inspecUon of the electric�al uvork at
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