P - 76184REQUEST FOR ELECTRICAL INSPECTION
2 � � 7 � � � � � � Minnesota Board of Electricity �
1821 University Avenue Suite S-128, Saint Paul, Minneso
(651) 642-0800 TTY/MRS 1-800-627-3529 www.edec �
D�scdbe -using the back ofk�ie'vrhite copy'rf necessary - the work crovered by this requsst: �
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GENERAL FEES Outdoor Lighting Standard @$1
SERVICES / POWER SUPPLIES Traffic Sipnal Standard C�D $5
Includes the Service andlor Power Supply up to 500 Amper�, All
Circu(ts and Two Inspectlon Trips Each Dwelting Unit @$80
UITS, CIRCUITS OF LESS THAN 50 VOLTS At
Each S em Device or s@$.50 Im
ADDITIONS TO THE GENERAL FEES Ra
fIFAMILY DWELLINGS PER UN
3 to 12 Un'ds @$50 Per Unit
Each Addfimral Unit @ $25
OTHER ADDffIONAL FEES
Lighting Retrofit $25 r Fbdure I hereby
Cer�ter Pfvot Irri a8on Boom $40 R01°' �'
Manufactured Home Park Lots $25
Recreational Vehide Park Sit�s (a) $5 �""` �':`
Fee
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TOTALFEE
total fee is $20) � �� ��
tl�at I hispeded tlm electricel instellatlon d�cn� hereln on ttre dat�s siat�:
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D�: Rough-in Inspedion Requfred? ❑Yes � Inspedion OtherThan Rough-In:�`Ready Now ❑NM Ca0 I
l(� '� 6'(d�p You must wll tlre inspedor when readyl Date Ready. /�� i� � Q�
I c8rtiify that I am the �,LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at