P - 75846� REQUEST FOR ELECTRICAL INSPECTION `
1� 9 21 � 7 2 2 � Minnesota Board of EI
1821 University Avenue S' 8, Saint Paul, Minnesota 55104
, (651) 642-0800 TTY/M ' 7-3529 www.electricity.state.mn.us
' Describe -' ba�k of the white copy'rf necassary- ork cover�i this u:
1'�.i
GENERAL FEES Outdoor Lighting Standard @$1
, SERVICES / POYdER SUPPLIES Traffir. Slanal Standard rmi R5
� CIRCURS, CIRCURS OF LESS THAN 50 VOLTS
Each S m Device or Apparalus @$.50
ADDITIONS TO THE GENERAL FEES
$50 Per Unit
Unit @ $25
CeMer
Special Ir�spectlon @ $30 er Hour
S I Ins 'on @$.31 r MIIe
THIS I�ISTALLATION MAY BE ORDERED
IIIUIIlUl1I1111I�IIlUIIIIIIIIIIIIIII�W�Wl4
19217223
Transformars over 10 KVA $ Ztl
Transformer / Power Su for Si s/ OuUine Li htin $5
ONE & TWO FAMILY DVdELLINGS, EACH UNR
Includes the Service andlor Power Supply up to 500 Ampere,a, All
Circuils and Two Inspection Trips Each Dwelfmg Unft @$80
Addi6'onal Ins 'on Tri $2Q
Imesti ative Fee
Reirrs on F� @ $20
TOTALFEE
(minimum total f� is $20) ,�
tws a�a Fae usrECron t� onar
I hereby t�r6fy fhat I I�edad tlre electr�l ireta0atlon des��ed hetein on fhe dat� st�ed:
iCONNECTED IF NOT COMPLETED WITHIN 12
FOR OFFICE USE qNiY
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I��� ��Rough-(n Inspecdon Requlred4 ❑Yes �No I�on Otl�er Than Rough-In: �Ready Noar OWpI Ca0 I
You must cap the Inspedor when ready! Date Ready.
I certdy that I am the�.LICENSED CONTRACTOR C�7 COMPANY ❑ OWNER ar►d hereby request mspection of the electripl wurk at
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or
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iw�e �c:omracror or �smuedQn��" ►
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BACK OF YELLOYN COPY BOARD OF ELECTRICITV f`.nPV
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