P - 76076REQUEST FOR ELECTRICAL INSPECTION °�,:
� 1— O��- 2 81 0 Minnesota Board of Electricity
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104 �
(651)642-0800TTY/MRS 1-800-627-3529 rovww.electriciry.state.mn.us 'H� '"�
Describe -using the k°F the�/C.+ coPY ff�4' /�the work�red� reQue.at:
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G FEES Outdoor Lightin Staridard @$1
I SERVICES/
ALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aooaratus Ca� $.50
untt
Cer�ter Pivat
Traffic Signal Standard � $5
Su ��lemernal Fee @ $20
Transformers u to 10 KVA $10
Trartsformers over 10 KVA $ 2(1
Transformer I Power Su I for Si ns / OuUine Li hUn $5
ONE & NUO FAMILY DWELLINGS, EACH UNIT
Includes the Service antllor Power Suppty up to 500 Amperes, M
Circufts and Two Inspec�on Trips Each Dwe�ing Unit @$80
tatal fee is
I hereby cerWy that I Napected fhe electrfcal ir�atlon desatbed frerefn on ihe da�es a�ted:
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5 " I�pe,c�on @ $.31 r MUe
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITF
�OR OF�ICE USE �N! Y
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� g pectlon Required? ❑ Y� o Inspecdon Olher Than Rough-In: ❑ Ready Now �I Cap
�' ��� You must call the inspedor �ifien ready! Date Ready:
I certify that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspectlon of the electrical work at
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BACK OF YELLOW COPY
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