P - 78407REQUEST FOR ELECTRICAL INSPECTION
1�`t �.J �- 2� 5� Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
�J����,J� (651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
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❑ NEW 0 REMODEL 0 ADDITION REPAIR Describe -using the back of the white cop if necessary - the work covered by this request:
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GENERAL FEES Outdoor Li htin Standard $1
SERVICES I POWER SUPPLIES Traffic S' nal Standard $5
0 to 400 Am re $25 `/� -�if�J Su lemental Fee $20
IALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aooaratus � 5.50
OTHER ADDITIONAL FEES
Ligh6ng Retrofit � 5.25 per Fi�ute
Center Pivot Irriaa6on Boom � S40
Transformer / Power Su I for Si ns I Outline Li htin $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes ihe Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspec6on Trips Each Dwelling Unit �$80
Additional Ins tion Tri $20
Inves' ativeFee
Reins tion Fee $20
TOTALFEE �
(minimum total fee is $20) �
TFNSRREAFp3NSPECTq2USE Y _'1.
I hereby I inspeckd the Eescribed q�aatr��
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Request et � Rough-in Inspedfon Required? ❑ Yes No Inspection Other Than Rough-In: ❑Ready Now WRI CeN
�� O� You must call the inspector when readyl Date Ready: ,
I cefify that I am ttie UCENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request mspection of ttie electrical wwk at:
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