P - 760411 7 8 7 0 5 5 1 REQUEST FOR ELECTRICAL INSPECTION
� � ❑ Minnesota Board of Electricity
1 8 2 1 Univers i t y Avenue Sui te S- 1 2 8, Sain t Pau l, Minneso t a 5 5 1 0 4
(651) 642-0800 TTY/MRS 1-800-627-3529 www.elecrizcity.state.mn.us
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� � GENERAL FEES Outdoor Liahtina Standard (�a �1 I
POWER SUPPLIES
Standard
Fee na $
iu Evn re m�5 ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
200 Am re$10 Includes the Service and/or Power Supply up to 500 Amperes, AII
�AaIUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unft @$80
CIRCUffS OF LESS THAN 50 VOLTS Addifional Ins ction Tri @$20
i tem Device or Apparatus @$.50 InvesUgative Fee
ADDITIONS TO THE GENERAL FEES Reins ction Fce @$20
lLY DWELLINGS PER UNI TOTAL FEE �(j. �O
! Uni�s @$50 Per Unit (minimum total fee is $20)
1dd'ItiIII121 UnR @$25 nnsa�aFOa MsrecroR us� ow r
OTHER ADDITIONAL FEES
R2ttOfit @$.25 f FlXtufe i hereby certify thal I inspected the el�trical installetion dascribed herein on the dates stat�:
Hour
� t11lSTALLATIOW AAAY BE ORDERED
I I�I � I� ��1 il I� II �I � i� II ill �� II �i 11�1
1787055],
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IOT COMPLETED WITHIN 12 MONTh
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"8%�.�t/06 Rough-InlnspectionRequired7 ❑Ye� �]No InspectlonOtherThanRough-In: [�ReadyNow❑WIIICaII
You must call the inspector when readyl Date Ready:
I c�fy that I am the f�J LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
�N9TRUCTIQN9 ON @ACK OF YELLOW COPY BOARD OF ELECTRICITV COPV FA IVMlM e�t o� annn