P - 761021 7 8 7 0 61 � REQUEST FOR ELECTRICAL INSPECTION
� � Minnesota Board of Electriciry i
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.elecri•icity.state.mn.us
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GENERAL FEES Outdoor Lighting Standard @$1
SERVICES / POWER SUPPLIES Traffic Sianal Standard C� $5
MAMUNICATION, REMOTE CONTROL,
CIRCUITS OF LESS THAN 50 VOLTS
ivstem Device or Aooaratus na $.50
Each Additional Unit @
Fixture
Transfortners u to 10 KVA $10
Transformers over 10 KVA $ 20
Transformer / Power Su I for Si ns I OuUine Li htin $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unft @$80
AddiGonal Ins 'on Tri $20
Investlgative Fee
Reins ction Fee @ $20
TOTAL FEE ^�Qe iQ
(minimum total fee is $20)
nnsa�a Fon wsaECroa use au�r
I hereby certifv that I inspeded the electrical installatlnn described herein on tl�e dates steted:
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'�I Ins ' n @ $.31 per Mlle
THI$1At�uTALLAiION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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nete: Rough-inlnspectionRequired7 ❑Ye $]No InspecbonOtherThanRough-In: [�CReadyNowOWillCall
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You must call the inspector when readyl Date Ready.
I arp4y that I am the L�J LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at