P - 76383REQUEST FOR ELECTRICAL INSPECTI �
2 � � � � ,�' S � � Minnesota Board of Electricity � � �� g �0 �,� � �°�
� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
. (651) 642-0800 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us
Describe -using fhe back of the white copy if necessary - the work covered by this request:
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GENE FEES Outdoor Li htin tandard @$1
SERVICES I POWER SUPPLIES Traffic S' nal Standard $5
0 to 400 Ampere (a� $25 Supplemental Fee @$20 _
ALARM, COMMUNICATION, REMOTE CONTROL, SIGI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A paratus $.50
ADDITIONS TO THE GENERAL FEES
Each Additional Unit @ $25
OTHER AC
Lighting Retrofit @ $.25 per I
Center Pivot Irriqation Boom
ONE 8 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
� Investiaative Fee
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total fee is $20) c� ���Q
I inspected the elecfical installation desaibed herein on the dates stated: �
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S 'al Inspection $.31 r Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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Date: Rough-in Inspection Required? ❑Yes o Inspedion Other Than Rough-In: � Ready Now ill Call
1 I 7/D 7 You must call the inspector when readyl Date Ready:
I certi(y that I am the CENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work ai
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