P - 76459REQUEST FOR ELECTRICAL INSPECTION �
1� 1 V 1- 9 3 8 8� Minnesota Board of Electricity �rr _
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TiY/MRS 1-800-627-3529 www.electricity.stute.mn.us
Describe -using the back of the white copy if n the �wk ,ered,byt.t�is ��,y}uegt ,-. `'.��� ;_ � 3,
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GENERALFEES
0 to 200 Am ere $5
Above 200 Ampere @$10
ALARM, COMMUNICATION, REMOTE CONTROI
GRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Apparatus an $.50
FEES
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIO
Liahtina Retrofit C�a $.25 aer Fixture
Outdoor Lighting Stana
Traffic Siqnal Standard
� Transformer I Power Supply for Signs I Outline Lighting @�5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes ihe Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Fee $20
TOTAL FEE :?(_`„
nimum total fee is $20)
the electrical installation descnbed herein on ihe dates stated:
u rate Bondi ~Ins 4 tion $20 ��Z "a
Sp2C121 InSpCCfiOn $30 p8f HOUf ExaiaEO�aear�ooweo onTe
S cial Inspection @$.31 per Mile
TFF1S IMSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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Rough-in Inspection Required? ❑ Yes ��] No j Inspection Other Than Rough-In: [�Ready Now � Will Call
You must call the inspector when ready! ', Date Ready:
I certify that t am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
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