P - 760031 7 8 7 0 5 2 g❑ REQUEST FOR ELECTRICAL INSPECTION
� � Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
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. '' (651) 642-0800 TlY/MRS 1-800-627-3529 www.electricity.state.mn.us
Desaibe -txing th�k of the white capy'rf n���,e �� -��'r�'��st' S SW T TCH I
GENERAL FEES Outdoor Lighting Standard @$1
SERVICES / POWER SUPPLIES Traffic Sianal Standard (")a $5
JPA&7UNICATION, REMOTE CONTROL, SIGNALING
CfRCURS OF LESS THAN 50 VOLTS
i�stem Devit:e or Apparatus @ $.50
ADDITIONS TO THE GENERAL FEES
Park Lots
tNST�LLATIOPI MAY BE ORDERED
II� � I� II il� II �I II Ifl � I� II III II NI
III�IIIII
17B7D528
Transfortners over 10 KVA $ 20
Transformer I Power Su I for Si ns I Outline Li h8n $5 �
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Suppty up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additional Ins bon Tri s$20
Investigative Fee
Reins ctlon Fee @ $20
TOTAL FEE gQ, d Q
(minimum total fee is $20)
THIS ARE4 FOR PlSPECTOR USE ONLY
I heraby certify that I inspected tl�e electrical insfellatlon described herain on the dates steted:
WITHIN 12
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��' Rough-in Inspection Required7 ❑ Ye �] No InspecGon OtherThan Rough-In: [�Ready Now ❑Will Call
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You must call the inspector when ready! Date Ready:
t cerMy that I am the L�l LICENSED CONTR�4CTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
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Please Provide Two (2) Phone Numbers Including Area Code
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Utility Address
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Please Provide Two (2) Phone Numbers Including Area Code
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