P - 75899REQUEST FOR ELECTRICAL INSPECTION
10 ���� 2 6� � Minnesota Board of Electricity
1821 Universiiy Avenue Sufte S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.edechicity.state.mn.us
back of the white copy'rf n�essary - the work covered by this requ�st:
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� GENERAL FEES Outdoor Lighting StandaN @$1
SERVICES / POWER SUPPLIES Traffic Signal Standard @$5
n m dnn am�.� r� ��s ; Suonlemerital Fee C� $20
Abotre 200 Am ere $10
ALARM, COMMUNICATION, REMOTE CONTROI
CIRCUITS, CIRCUfiS OF LESS THAN 50 VOLTS
Each Addfional Unit @
OTHE
Liahtina Retrofit C� $2:
Transformers over 10 KVA $ 20
Transformer / Power Suppty for Signs / Outlirre Lighting @$5
ONE & TWO FAMILY DWELLINGS, EACH UNR
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits arM Two Ins�tion Trips Each Dwelling Unit @$60
F� a $20
TOTALFEE
iimum total fee is $20) ,��j' � �
electrinl mstalla6on descri�d herefn on fhe datea sfeffid:
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pection @$.31 per Mae � �
'�►LLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED 1MTHIN 12
r'OR OF�:C_ UsG O�1L:,
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19912609 ������I��
��� Rough-in Inspectlon Requir�i9 ❑ Yes �No Inspecdon Other Than Rough-In: ❑ Ready No WAI Call
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You must call the Inspedor when readyl Date Ready.
I cefi(y that I am e ICENSED CON7'RACTOR ❑ COMPANY ❑ OWNER and hereby request inspec�on of the electrical work at
Job Site Street Address City
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Contrador Licer�se Number Master Electridan or Power
�� /�� Ucense Number
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Please Provide Two (2) Phorre Plumbers clui
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