P - 761291 � � � � � � � REQUEST FOR ELECTRICAL INSPECTION
� � ❑ Minnesota Board of Electricity i
1821 University Avenue Suite &128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 9-800-627-3529 www.electricity.state.mn.us
�-using the back�Yhe white cop ff necessary - the arork cove by this requ�st:
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GENERAL FEES Outdoor Liahtina Standard na �1
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Startdard
iu Flm re m� ONE & TWO FAMILY DWELLINGS, EACH UNR
200 Am re$10 Includ� the Service and/or Power Supply up to 5U0 Amperes, All
)MMUNIGATION, REMOTE CONTROI„ SIGNALING Circufis and Taro Inspection Tdps Each Dmre�ing Unft @$80
CIRCUITS OF LESS 1'HAN 50 VOLTS Addfional Ins 'on Td $20
i m Device or Apparatus $.50 Invesdgative Fee
ADDI770NS TO THE GENERAL FEES Reins on Fee $20
ILY DWEWNGS PER UN TOTAL PEE
� units @ $50 Per unit (minimum total fee is $20) � � � ,��
lddftional Unit @ $25 �^�^����a+��Y
OTHERADDITIONAL FEES
RBVoffi (a� $.i5 per FIXtufe I hereby certHy that I tr�apeded tlre electrical Instailatlon de�ihed herahi on the dates slaied:
Pivot Irti aUon Boom �$40 "�' �+ unre
3dured Home Park Lots (a� S25
acial Inspectlon @ $.31 per MHe
INSTALLATION MAY BE ORDEREI
I�� IIUI �III �I� III� II�i IiIII III� �� I�
19967371
1F NOT
FOR OFFICE USE ONLY
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"""''�7 Rough-in Inspectlon Requfr�iT ❑ Y� ❑ No InspeWon Other Than Rough-In: ❑ Read�Catl
l� i1 ��� You must call the inspector wfien readyi Date Ready.
I cerfdy that I am the SED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request insp�.fion of the electrical work at
Job Site Street Addr�s �hy
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Ig�retu�e (Corihactor or Owner g I on) Please provide T
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i ON BACK OF YELLOW COPY BOARD OF ELECIRICITY COPY
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