P - 759149 REQUEST FOR ELECTRICAL INSPECTIOIV ' '
2 0 01 �� 3� J� Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-500-627-3529 www.electricity.state.mn.us
Dasai -using e ck of the white copy'rf w coEyered by this uest:
GENERAL FEES Outdoor Lightin Standard @$1
SERVICES / POWER SUPPLIE&Q Traffic Sianal Standard id $5
Above 200 Am ere a$10
ALARM, COMMUNICATION, REMOTE CONTROL, SIG
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S m Device or A ratus @$•50
ADDITIONS TO THE GENERAL FEES
to 12 Units @$50 Per Unit
Lighting Retrofit
Cerder Pivot Irrii
5' I Inspecfion $30 per Hour
Special Inspectlon @ $.31 {�r M8e
THIS INSTALLATION MAY BE ORDERE[
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I certiiy that I am the
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I Transformer / Power Supply for Signs / OuUme Li td'mg $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Indudes the Service andlor Power Supply up to 500 Ampere.a, AO
Cira»ts and Two Irtis�on Trips Each Dwelling Unit @$80
Additional Ir�sa�tion Trlos C�D $20
TOTALFEE
total fee is $20) �� -a���
tl�t I NsP�ded the elecMcal mstallatlon desc�ed herein on fhe datas sta0ed: I
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'ED IF NOT COMPLETED WRHIN 12 MONTHS
FOR<'�i'F�Cc ii�:E r�tr'iy
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Rough-inlnspecdonRequired9 ❑Yes ❑No InspecttonOtherThanRough-In�dyNowOWt�Call I
You must call the inspedar when ready! Date Ready:
VSED COMRACTOR � COMPANY ❑ OWNER and fiereby request inspection of the elecfical work at
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