P - 761241 7 H 7 O 7 5 � REQUEST FOR ELECTRICAL INSPECTION
� � Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electr�icity.state.mn.us
DBSCi4he -using the back ot �1e white copy'rf ne�e�the ��.nuered.-by�i'��s�, �t: s SW T TCH
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GENERAL FEES Outdoor Lighting Standard @$1
Sk'RVICE51 POWER SUPPLIES Traffic Signal Standard @$5
0 to 400 Ampere $25 Supplemental Fee @$20
401 to 800 Am re $50 Transformers u to 10 KVA $10
Above 8� Am re $75 Transformers over 10 KVA $ 20
CIRCUIiS / FEEDERS Transfortner I Power Su I for Si ns / Outline Li h6n $5
0 to 200 re$5 ONE & TN10 FAMILY DWELLINGS, EACH UNIT
Ahove 2D0 Am re$10 Includes the Service and/or Power Supply up to 5�0 Amperes, All
AI.ARM, COPAMUNIGATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unft @$80
CIRCUlT3, ClRCUITS OF LESS THAN 50 VOLTS Additional Ins cBon Tri $20
S tem Devir,e or A paratus @$.50 Inves6gative Fee
__ _ ADDITIONS TO THE GENERAL FEES Reinspection Fee na. $20
5 per Fixture
Boom an. $40
� II�1I III IIu� II I� If ul (I I� A lu ��A I) III ( lu)
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total fee is
that I Inspected the electrlcal Installation descrlbed herein on the dates s�fed: I
DISCONNECTED_IF NOT
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r
ITHIN 12 MONTHS
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�' Rough-in Inspection Required7 ❑Ye 7� No Inspection OtherThan Rough-In: �iReady Now ❑Will Cell
$` �' �l�� You must call the inspector when readyl Date Ready:
I c�ify that I am the [� LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
BpSTRt)CTIONS ON BACK 6F YELLOW COPY BOARD OF ELECTRICITV COPV FR-OM01 G.15 a� �nne