P - 75896REQUEST FOR ELECTRICAL INSPECTION
� � 9 � � � 4 � � � Minnesota Board of Electricity
1821 Univers(ty e e Suite 5128, Saint Paul, Minnesota 55104
(651)642-0 MRS1-800-627-3529www.edectricity.state.mn.us
D�ai -usir�g�e ` the white copy'rf n - work s request:
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GENERAL FEES Outdoor Lighting Standard @$1
SERVICES / POWER SUPPLIES Traffic Sianal Standard al� $5
tM, COMMUNICATION, REMOTE COMROL,
;UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aooaratus na $.50
�
Pivot Irtiaation Boom
TfdnSfortliers oVef 10 KVA $ ZO
Transformer / Power Suppiy for Signs / Outline Lig ' $5
ONE & TWO FAMILY DWELLINGS, EACH UNR
Includes the Service and/or Power Supply up to 500 Am�ras, Atl
Cira�ts and Two Inspedion Trips Each Dwe�ing Unit @$80
Addfionallns�ectionTd s a $2Q
Imestlgative Fee
Reins ecbon Fee @ $20
TOTAL FfE �yd
(minimum total fee is $20) .�a(C�
i
I hrepeded tlre electrlcal N�on desa�ed hereln on fhe dat� s�ed:
onre
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S � Ir�s on @$.31 r Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITF
FOR OFFICE USE ONLY
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��' Rough-in Inspectlon R�utred? ❑ Y� ❑ No I on Other Than
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You must can the inspector when readyl Date Ready:
I cer�fy that I am the LICENSED WNTRACTOR ❑ COMPANX ❑ OWNER and hereby requ�t i�pection of the electrical work at
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INSTRUCTION9ON BACK OF YEL OPY BOARO OF ELFCTRICffV (:f1PV
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�se Number esmr ElectrlGai
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Please Provide Two (2) Phorre Nurr
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