P - 76396REQUEST FOR ELECTRICAL INSPECTION
1 s� 8�, �w �� 5 � Minnesota Board of Electricity
1821 Uni ersity Avenue Suite S-128, Saint Paui, Minnesota 55104
(6 - 00 TTY/MRS 1-800-627-3529 wxryv.electricity.state.mn.us
�4
Describe -using the back of the white copy if necessary e red by this request:
FEES
I SERVICES I POWER
Above 200 Am ere $10
ALARM, COMMUNICATION, REMOTE CANTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus $.50
ADDITIONS TO THE GENERAL
3 to 12 Units @$50 Pe
Each Additional Unit @
� Retrofit @ $.25 per Fi�
Pivot Irrigation Boom �
ctured Home Park Lots
���
Outdoor Lightin Standard $1
Traffic Si nal Standard @ $5
Supplemental Fee $20
Transformers u to 10 KVA $10
Transformers over t0 KVA $ 20
Transformer / Power Su I for Si ns 1 Oudine Li htin $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additional Inspection Trips @ $20
Investigative Fee
TOTALFEE /��
total fee is $20) r}�(.> `
I insoeded the electrical installation described herein on lhe dates stated:
��/�''�`"..—..��
S INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WlTHIN 12
- ��'`? �
I IIII II III II lii II III IIlII II Ili II lil II III �� I�I2 C���J ��'1�,/,
L 9 8 4 1 1 5 4 =J "�l> "� / ,��7" <J" TG�
Date: Rough-in Inspection Required? ❑Yes �Jo Inspection Other Than Rough-in: �Ready Now �Will Call
�� a�� You must call the inspector when ready! Date Ready: �$��
I certify that I am the'�.LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at: