P - 76985REQUEST FOR ELECTRICAL INSPECTION
2� 5 l9 `� 2 9 o Minnesota Board of Electricity
���� , • 1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
(65�1)642-0800TTY/MRS t-800-627-3529 www.electricity.state.mn.us
L���jpg-�ngp� badc of n R� copy d necgssary - tlre wak cov by this request:
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GENERAL FEES Outdoor Li hti Standard $1
SERVICES / POWER SUPPLIES Traific Sipnal Starxiarcl �$5
IALARM, COMMUNICATION, REMOTE CANTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or ADDaratus �$.50
Each Additional Un8 � 525
OTHER ADDITI01
Lqhling Retrofit (di $25 per Fixture
Indudes ihe Service andlor Power Supply up to 500 Amperes, All
CircuiGs and Two InspecUon Trips Each Dwelling Unit � 380
Additional Inspection Trips Q $20
InvestioaWe Fee
total fee is
I hereby cw6ly that I inspected ttie electrical instaNaUai desaibed I�rein on Cie detes sfated: �
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�' Rough-in Inspection Requi�ed7 ❑Yes No Inspedion OU�er Than Rough-In: ❑ Ready Now Call
/� � You must call the inspector when ready! Date Ready:
I cerMy Uiat I am the CENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspe�ion of ihe electricai worlc at
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Range Fire No. CouMy
Please Provide Two (2) Phone
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P T 2) Phone Numbers Induding �
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