P - 76043REQUEST FOR ELECTRICAL INSPECTION
1- 7 8 7� O 8 1 � Minnesota Board of Electricity �
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800�27-3529 www.elech-icity.state.mn.us
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GENERAL FEES Outdoor Lighting Standard @$1
SkRWCES / POWER SUPPLIES Traffic Signal Standard @$5
0 to 4D0 Ampere $25 Supplemental Fee @$20
1 to 600 Am re$50 Transformers u to 10 KVA $10
� Above 800 Am re $75 Transformers over 10 KVA $ 20
CIRCllITS I FEEDERS Transformer / Power Su I for Si ns I OuUine Li hUn $5
0 to Z(}D $5 ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
P�hwe 200 Am $10 Inciudes the Service and/or Power Supply up to 500 Amperes, All
RL0.RM, COAIMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit @$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Addfional Ins ction Tri @$20
Eech S tem Davice ot A paratus @$.50 Investigatrve Fee
ADDITIONS TO THE GENERAL FEES Reinspection Fee (�a. $20
Fixlure
5 ecial Inspection a$.31 per Mile
THI$ INSTALlATIOf� MAY BE ORDE
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178708�7
total fee is
that I inspected the electrical installatlon described herein on tlre dat� slat�: I
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DISCONNECTED_IF NOT COMPLETED WITHIN 12 MONTHS _____ _�
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Rough-in Inspection Required7 ❑ Ye � No Inspection Other Than Rough-In: [�Ready Now 0 Will Call
�, �' �,� � You must call the inspectar when ready! Date Ready:
I cerMp that I am the LRI LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
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