P - 760641 7 8 7 0 4 7�g REQUEST FOR ELECTRICAL INSPECTION
� � Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
'-using the back of the white copy'rf ne���ne ����,y�i��r. � Sl� I T�H
GENERAL FEES Outdoor Liuhtina Standard C�a $1
CIRCURS, CIRCllITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL FEES
Unft
i Inspectlon $30 er Hour
�cial Inspection @ $.31 per Mile
� fNSTALLATION MAY BE ORDERED DISCONN
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17870478
� Trensformers up to 10 KVA @$10
� Transformers over 10 KVA @$ 20
Transfortner / Power Supply for Signs / Outline Lightin $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Pawer Supply up to 500 Amperes, All
Circuits and Two Inspecqon Trips Each Dwelling Untt @$80
TOTAL FEE �Q,
total fee is $201
electrical installe6on described hereln on the dates stated: �
VYITHIPI 12
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I"���� J�� Rough-in Inspectlon Required? ❑ Ye� �] No Inspection Other Than Rough-In: [�Ready Now ❑ Will Call
You must call the inspector when ready! Date Ready:
l r,ertjfy that I am the C*J LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
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� Address Contrectar Company ar Owner Performir
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Please Provide Two (2) Phone Numbers
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:oMractor License Number Master Electrician or P
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Please Provide Two (2) Phone Numbers I
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