P - 76002REQUEST FOR ELECTRICAL INSPECTION
1� 7 8 7� 0 6 2 � Minnesota Board of Electricity ;
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us
9esGri� -�,sing ttre'ba�i of the whKe copy'rf ne���na ����y����r, S SW I TCH
GENERAL FEES Outdoor Lightin Standard @$1
S�RViCES / POWER SUPPUES Traffic Sianal Standard (�a �5
)11661UN1CATION, REMOTE CONTROL,
CIRCUITS OF LESS THAN 50 VOLTS
ivstem Device or Apparatus an. $.50
5 per Fixture
Boom a(�. $40
WSTALLATION AAAY BE OR�
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Supptemental Fee @ $20
Transformers up to 10 KVA @$10
Transformers over 10 KVA an $ 20
Includes the Service and/or Power Suppiy up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
total fee is
thal I inspected the electrical inspllaticn
IF NOT COMPLETED W
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I s�� j�� Raugh-in Inspectlon Required? ❑Ye�
� No Inspecdon Other Than Rough-In: [�Ready Now 0 Will Catl
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I You must call the inspector when ready! Date Ready:
I c�rtify that I am ihe L� LICENSED CONTRACTOR � COMPANY ❑ OWNER and hereby request inspection of the electrical work at
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� C� � Piease Provide Two (2) Phone Numbers I
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Electripl UtllityAddress
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Name Contrac[or License Number Master Electrician or P�
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ector, Company or Ovmer Performin Installation)
I1'�]hIAL ROADq SA�hlT F'AUL, f�hi 55i14
(Contractor or Owner Performing Installation) Please Provide Two (2) Phone Numbers I
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