P - 76071REQUEST FOR ELECTRICAL INSPECTION
� � � � � — q, � 7 � Mi�nesota Board of Electricity
,, 1821 University Avenue Sufte S-128, Saint Paul, Minnesota 55104 -
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us
Descn'be -using the back of the white copy'rf nece.ssary - the work covered by this requ�st:
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GENERAL FEES Outdoor Liuhdna Standard Ca� $1
0 to 400
)MMUNICATION, REMOTE CONTROL,
CIRCUITS OF LESS THAN 50 VOLTS
Boom
INSTALLATION MAY BE ORDERED [
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18204677
Transformers u to 10 KVA $10
Transformers over 10 KVA @� 20
Tra�fortrter / Power Suppty for Signs / Outline Lighting @$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includ� the Service and/or Power Supply up to 500 Amperes, AU
Circuits and Two Inspection Trips Each Dwellhig Un8 @$8
Additional Ins �ectlon Tdps @ $20
Investigabve Fee
Reins ecUon Fee @ $20
TOTALFEE
(minimum total fee is $20)
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IF NOT COMPLETED WITF
FOP, c7� rt':E USE. ONLr
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��' Rough-fn Inspection Requhedl �Yes ❑ IVo Inspecdon Ofher Than Raugh-In: ❑ Ready Now ❑VWi Call
�/� /�� You must call the inspe�or when readyl Date Ready:
I certify that I am the 0 UCENSED CONTRACTOR ❑ COMPANY,,�OWNER and hereby requ�st inspection of the electrical work at
Job Site Street Address �
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Addr�s (CoMractor, Compeny or
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License Number Master Eledridan or Power Limited T
Licer�se Number
manon� Please Provide Two (2) Phorre Numbers Irtduding Nre
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