P - 76394REQUEST FOR ELECTRICAL INSPECTION �`�
2 _ a� Minnesota Board of Electricity ��
��� ��� � 1g21 University Avenue SuRe S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us
Describe -using the}�ack of the white copy i ary - Ne work covere this request:
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GENERAL FEES Outdoor Lighting Standard $1
SERVICES I POWER SUPPLIES Traffic S' nal Standard $5
0 to 400 Ampere id $25 Supplemental Fee @$20
ALARM, COMMUNICATION, REMOTE CONTROL, SIG
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A paratus �$.50
ADDITIONS TO THE GENERAL FEES
Each Additional Unit @ $25
OTHER AC
Lighting Retroffi @ $.25 per',
Center Pivot Irriaation Boom
ONE & TWO FAMILY DWELLINGS, EAGH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Ciraits and Two Inspection Trips Each Dwelling Unit @$80
Additional Inspection Trips @ $20
Investiaative Fee
(minimum total fee is
I herebVi certifV ihat I inspeded fhe eleciriral inslallation described herein on the dates stated: �
, 2
�pection $.31 per Mile I I
ALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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Date: Rough-in Inspeclion Required? ❑ Yes � I7ro Inspection Other Than Rough-In: eady Now ❑ Will Call
, �� You must call the inspector when ready!N Date Ready:
I ce' that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Site Street Address ��Y
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ictrical Utility Address
Contrador License Number
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Jumbers InGuding Area Code
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