P - 77240REQUEST FOR ELECTRICAL INSPECTION
1� 610 -� 9 5� Minnes� Board.of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TlY/MRS 1-800-627-3529 www.electricity.state.mn.us
❑ NE�j� REMODEL ❑ ADDITION _ REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
GENERALFEES
SUPPLIES
0 ►0 400
401 to B
200
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Ea�h S stem Device or aratus 5.50
ADDITIONS TO THE GENERAL FEES
$50 Per Unit
Unit @ $25
25 per Fixture
iBoom @ S40
Park Lots $
Park Sites ;
� Gon $21
330 cer Hour
Outdoor
Traffic S
� Transformer I Power Supply for Signs / Outline Liqh6nq ,$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlw Power Supply up to 500 Amperes, All
Circuits and Txro Inspeclion Trips Each Dwelling Unit �$80
TOTAL FEE I ��
(minimum total fee is $20) � �
iH15 MEA FOR INSPECTpi USE OKV
I hereby cer6(y that I inspecBed the elecOric� insWla6on described herein on the dates sGted:
/� _ ���� �I
������������i������������������������������ ����� !� _ /�L., �
16L0695? fit"�� �v✓�
nequesc ua : Rough�n Inspection Required? ❑ Ves B No Inspedian pther Than Rough-In: eady Now � Will Call
/ \
You must call the inspecla when readyl Date Ready:
I certiTy that I am the ICENSED CONTRACTOR ❑COMPANY ❑ OWNER and hereby request inspection of tlie electrical work at: