P - 76990REQUEST FOR ELECTRICAL INSPECTION
� 1� 8 2 O�? 5 7 Minnesota Board of Electricity
s 1821 University Avenue SuRe S-128, Saint Paul, Minnesota 55104
�= (651f 642-08001"TYIMRS 1-800-627-3529 www.elecbiciry.state.mn.us
Describe -using the back of the e copy if necessary - the work covered by this
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GENERAL FEES Outdoor l' Mi Standard S1
S VICES / POWER SUPPLIES Trafic S' nal Sfandard $5
0 to 400 Am re 525 �,. SupplemeMal Fee S20
1 to 800 Am re $50 Transfortners u to 10 KVA $10
Above 800 Am re $75 Transfortners over 10 KVA $ 20
CIRCUtTS I FEEDERS Transfamer / Pou�r Su for ' / Outline L' Mi i5
0 to 200 $5 ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am $10 Indudes the Service andlor Power Suppty up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CANTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit (a� $80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional In ' Tri $20
Each SVStem Device or Aooaratus �$.50 Investiaative Fee
Each Add'dional UnR (d�
OTHE
Lightirq ReUofit A! S.2°
Fce � $2(1
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iimum total fee is
I insoeaed the elec6icd
S' I Ins ' n 530 r Hour �"'"E0�"B"N00M�--�
Spedal Inspedion � $.31 per Mite
HIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHII
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herein on the dates sNated:
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1e`e' Rough-in Inspection Required? ❑ Yes ❑ No inspeclion Other Than Rough-In: � Ready Now iN CaN
����/O� you must cell the i�spector when ready! Date Ready:
I certify that I am the ❑ UCENSED CONTRACTOR O COMPANY ❑ OWNER and hereby request inspection of tlie electrical worlc at
Job Site Street Addre� C�y �
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Township Sec}ion Range Fire No. County
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Master Electrician w Pow�er Limibd
License Number
or owner Pe rtning Installatiop) Please Provide Two (2) Phone Numbers .
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