P - 76265� REQ�IEST FOR ELECTRICAL WSPECTION
1�� 7 1- 5 3 7� 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.mvr.us
Describe -using the back of the white copy'rf necessary - the work covered by this request:
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GENERAL FEES Outdoor Lighting Standard @$1
RVICES / POWER SURPLIES Traffic Siqnal Standard na $5
A�RM, GOMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
r� Each System Device orAoparatus (�a. $.50
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FEES
Transformers u to 10 KVA $10
Transformers over 10 KVA @$ 20
Transformer I Power Supply for Signs I Outline Lightlng @$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Povrer Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Fee
total fee is $20) � �_ �'�'
I inspected the electrical insfallation described herein on the datas sfeted:
� 7HtS !P�$TALLATION MAY BE_ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS ___
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���' Raugh-in InspecGon Requiredl ❑Yes � No Inspection Other Than Rough-In: �Ready Now ❑Will Call
�f ��. �.r J% You must call the inspector when readyl Date Ready:
I certiiy thai I am the �I LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
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Please Provide Two (2) Phone Numbers
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