P - 76154REQUEST FOR ELECTRICAL INSPECTION
2� 0 6�°� 4, o� Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.zrs
Desc �n9 th� ! k of the whit� copy t� - the wo covered by thP 1Slaq{►� �d ��F// �� �� �� �� `t •`
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GENERAL FEES Outdoor Liahtinu Standard a(�. $1
I SERVICES I
ADOVB GUU ARIp@(B (0��7U '
ZM, COMMUNICATION, REMOTE CONTROL, SIGI
�UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDRIONS TO THE GENERAL FEES
Pivot Irrigatlon Boom C
ctured Home Park Lo�
Transformers u to 10 KVA $10
Transfomters over 10 KVA $ 20
Transformer / Power Su I for Si ns / OuUine Li htin $5
ONE 8 TWO FAMILY DWELLINGS, EACH UNR
Includes the Service and/or Power Suppty up to 500 Amperes, All
I�N� Circuits and Two Irts�tion Trips Each Dwelling Unit @$60
Addfional I�s 'on Tri $20
Imestigative Fee
Re ' n Fee $20
TOTALFEE
(minimum total fee is $20) ��
Tf aS Ff�A FOR NL�EC70N 16E OMY
I herebvi certUv that I N� the et�trical 6�IIaHon desaibed herein on fhe dates sta�:
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�� Rough-in I�repectlon Required9 ❑ Yes Inspedion Otl�er Than Rough-In: � Ready N Ca0
� �� �� You ust call tlre inspector when readyl Date Ready.
I certify that I am the NSED CONTRACTOR ❑ COMPANY ❑ OWNER arM hereby request ins�Ction af the electrical work at
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OwnedOcaipant Name Please Provida Two (2) horte Numbers Including Area Code
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or Own Perf ing InstaOatlon) Please Provide Two (2) hone Numbers I
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