P - 760951 7 8 7 0 4 5 2� REQUEST FOR ELECTRICAL INSPECTION
- � Minnesota Board of Electricity
1821 Universdy Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
scrfbe -using the back of the white copy'rf ne���a `����y�'��t; S S�J I 1' CH
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GENERAL FEES Outdoor Liahtlna Standard (� $1
Traffic Signal Standard @ $5 "
Suaolemental Fee C� $20
f�� rtqutrc� Transfortner / Power Su I for Si ns / Outline Li htin $5
a ZQO $5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
ove 2� Am re $10 Includes the Service and/or Power Supply up to 500 Amperes, All
, CON�}MllNICATION, REMOTE CONTROL, SIGNALING CircuHs and Two Inspection Trips Each Dwelling Untt @$80
iS, CIRCUITS OF LESS THAN 50 VOLTS Addfional Ins ction Tri $20
� Device or Apparatus @$.50 Investigative Fee
ADDITIONS TO THE GENERAL FEES Reinspecdon Fee @$20
AMIl.Y DdVELLINGS PER UNI TOTAL FEE �, �
� 12 Units @ S50 Per Unfl (minimum total fee is $20)
Ch Adfilti0r�el Unit �$25 THIS AREA FOR INSPECTOR I1SE ONLY
OTHER ADDITIONAL FEES
hllllg RBtrofit Q$25 pBf FIXtU�e I hereby certify thffi I inspected the electrical installation d�cribed herein on fhe dat�
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6aidin Ins ion $20 _� �`� -t1�
S i�l Inspection @$30 r Hour �'"�"m �T�
� In on $.31 per Mile
iHF� 1{11$TAL.LATIOfiI MAY BE ORDERED DISCONNECTED IF NOT COMPLETED 1MTHIN 12 MONTHS
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1°`O' Rough-in InspecUon Requ(red7 ❑ Ye � No Inspection Other Than Rough-In: []6�eady Now ❑ Wfll Call
8/ ��f �� You must call the inspector when readyl �ate Ready:
I c�rtity that I am the � LICENSED COMRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electriql work at
BJ$TRl7CTlOMS QPI BACK OF YELLOW COPY BOARD OF ELECTRICITV COPV ca_nmm� e_�c n � ennn