P - 76039REQUEST FOR ELECTRICAL INSPECTION
1� 7 8 7� 0 5 1, � Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.edectricity.slate.mn.us
�scribe -usirtg the back of the white copy'rf ne�s� �ne v��r �ec�y ��r�t, �� 1�- C N
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` GENERAL FEES Outdoor Lighting Standard @$1
SERV S I PODU�R SUPPLIES Traffic Sianal Standard C�D $5
Transformers up to 10 KVA @$10
Transformers over 10 KVA an. $ 20
Above 200 Am re $10 Includes the Service and/or Power Supply up to 500 Amperes, All
AL4RM, CCNuBv1UNICATION, REMOTE CONTROL, SIGNALING Circuits and Tvro Inspection Trips Each Dwelling Unit @$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ction Tri $20
Each S �vice or Apparatus @$.50 InvesUgative Fee
ADDITIONS TO THE GENERAL FEES Reins ction Fee $20
MiILT�AMILY DWELLINGS PER UNI TOTAL FEE �,,,
3 to 12 Units @�5o Per Unit (minimum total fee is $20)
E3Ch AdditlOt�el UIIK @ $25 THISAREAFORM5PECTORUSEONLY
� OTHER ADDITIONAL FEES
Lightl�g Re6offi @$25 per FiXtufe I hereby ceitify that I inspected the electrical installaGnn described herein on the dat� sfsted:
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Bondin Ins cti¢n $20 �%�-,2�o C3^�
Speci8l Inspectian @ $30 per Hour °��D1PBA'IDONm �^T�
' In 'on @ $.31 r Mile
YHF$ INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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�� Rough-in Inspection Required? ❑ Ye $] No Inspection Other Than Rough-In: [jdReady Now 0 Will Call
�1 � 4,�� You must call the inspector vrhen readyl Date Ready:
I c�r6fy tliat I am the 0 LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
IN9TRUCTIONS Otd BACK OF YELLOW COPV BOARD OF ELECTRICITV COPY FR-OOnMA-15 R 1 9M1d