P - 76100'7 REQUEST FOR ELECTRICAL INSPECTION
1� 1 O�- 0 9 4 0� Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.elech^icity.state.mn.us
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GENERAL FEES Outdoor Liahtina Standard (�D $1
1N}RAUNICATION, REMOTE CANTROL,
CIRCUITS OF LESS THAN 50 VOLTS
iVStem Device or Apparatus (�a. $.50
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Transformers up to 10 KVA
Transformers over 10 KVA
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Addfional Ins 'on Tri $20
InvestigaUve Fee
Reinspection Fee @ $20
TOTALFEE g o„Q
(minimum total fee is $20)
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I hereby certify thet I inspected the electrical installation described herein on the datas sfef�:
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� TM1S fN�TAL4AT10N RNAY BE ORDERED DISCONNECTED_IF NOT COMPLETED WITHIN 12 MONTHS ________�
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"������� Rough-inlnspectionRequired? ❑Ye� �]No InspectionOtherThanRough-In:[�ReadyNow�WillCall
You must cali the inspector when readyl Date Ready:
I c�fy tttat I am the Cx] LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at