P - 76115REQUEST FOR ELECTRICAL INSPECTION
1� 7 8 7� O 7 1 � Minnesota Board of Electricity _'� i
1821 University Avenue Sufte S-128, Saint Paul, Minnesota 55104
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(651) 642-0800 TlY/MRS 1-500-627-3529 www.elech-iciry.state.mn.us
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/ POWER SUPPLIES
Outdoor
Supplemental Fee
Transformers up tc
Transformers over
200 Am re$10 Includes the Service and/or Power Supply up to 500 Amperes, All
N+A@AU(�ICATION, REPAOTE CANTROL, SIGNALING Circuits and Two Inspectlon Trips Each Dwelling Unit @$80
CIRCUITS OF LESS THAN 50 VOLTS Additional Ins cdon Tri @$20
iystem Device or Apparatus @$.50 Investigative Fee
ADDITIONS TO THE GENERAL FEES Reinspection Fee @$20
ILY DWELLINGS PER UNI TOTAL FEE �O, �(j
! Units @$5o Per Unit (minimum total fee is $20)
�ddd'Ib01121 Uliit @$25 TH44AREA FOR WSPECTOP USE ONLY
OTHfR ADDITIONAL FEES
g Retrofit @$25 �r Fixture I hereby certify thffi I Inspected the electri�l instelladon d�cribed hereln on fhe dafes stated:
Hour
I IIU II Iu II I� II lu u W� IU II I�I II II) II (u I IIII
1�87a�La
DISCONNECTED IF NOT
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S 141t?6 Rough-in Inspection Required7 ❑Ye� � No Inspection Other Than Rough-In: [�Ready Now OWfll Call
You must call the inspec[or when readyl Date Ready:
I�tl'dy that I am the C�] LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at