P - 761211 7 8 7 0 5 0� REQUEST FOR ELECTRICAL INSPECTION
� � Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 T1Y/MRS 1-800-627-3529 www.elecriicity.state.rrtn.us
Desrai� -using the back of the white copy if necess� ihe ��t�by �ii��t: $�� ��� H
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`� GENERAL FEES Outdoor Lighfing Standard @$1
$ERVICES I POWER SUPPLIES Traffic Signal Standard @$5
0 to 400 Am re@$25 Su plemental Fee @$20
401 to 800 Am re$50 ` Transformers u to 10 KVA $70
nlbove 800 Am re $75 Transformers over 10 KVA $ 20
GRCUITS I FEEDERS Transformer / Power Su I for Si ns / Outline LI htin $5
0 to 200 Am re $5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
46ove 20Q Am re $10 Includes the Service and/or Power Supply up to 500 Amperes, All
ALAEiM, Cd11A�tUNICATION, REMOTE CANTROL, SIGNALING Circutts and Two InspecUon Trips Each Dwelling Unit @$BO
CIRCUR3, CIRCUITS OF LESS THAN 50 VOLTS a�d�n��ai i���i�� T�� n a�n
� Retrofit @ $.25 per Fixture
Pivot Irriaation Boom Ca? $4[
�peGal Inspectian @ $.31 per Mile
i M18TALI.ATIQN MAY BE ORDERE
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I hereby certify that I inspecled the el�trical installadon described herein an the da0es sp�: �
:ONNECTED IF NOT COMPLETED
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� s i��d�+ Rough-inlnspectionRequired7 ❑Ye� �No InspectionOtherThanRough-In:[�ReadyNow�WillCall
You must call the inspector when readyl Date Ready.
I c�rtify that I am the C�J LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
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Please Provide Tvro (2) Phone Numbers
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:ontrac[or ucense Number Maste� Electrician or P
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Please Provide Two (2) Phone Numbers I
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