P - 75231REQUEST FOR ELECTRICAL INSPECTION
� � � � � � � � � � Minnesota Board of Electricity
1821 Universily Avenue Suite 5-128, Saint Paul, Minnesota 55104
O 1� (651) 642-0800 TTY/MRS 1-800-627-3529 www.edectriciry.state.mn.us
Describe -using the ba of 8 W� p� net�ssary - the wrork cbveered iy thiS �� � w��� �
GENERAL FEES Outdaor Liahtirw Standard C� $1
0 to 400
Trans(ortners over 10 KVA $ ZO
Transformer / Power Supply for Signs / Outiine Lightirtg @$5
ONE & TWO FAMILY DWELLINGS, EACH UNR
Includ� the Service andlor Power Suppty up to 500 Amperes, M
Circuits and Two InspecUon Trips Each Dwelling Unit �$80
URS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL FEES
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(minimum total fee is $20)
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I harebv cmd(v that I i�d tlre etecMcal i�feVaBnn aesa�bed herdn on Bre dat� steted:
Cerder Pivot Irrist�atlon Boom
INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT
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You mu� call the inspector when readyl Date Ready:
: I certify that I am the�LICENSED CONTRAGTOR ❑ COMPANY 0 OWNER and hereby request inspaction of ttre eledrical w�ark at
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��lOccwpaM Name 1,, Plea� Provide Two (2) Phone Numbets Im�uding Nea Cade
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Ucerree Number
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