P - 761231 7 8 7 0 4 8� REQUEST FOR ELECTRICAL INSPECTION
� � Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
�Crbe -using the back of the vdhite apy'rf ne���,e ���y���c> y 5ld T T C N
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CIRCUITS OF LESS THAN 50 VOLTS
iystem Device or Apparatus @ $.50
ADDITIONS TO THE GENERAL I
Home Park Lots
7HFS fHl$TALLATIOfU MAY BE ORDERED DIS
I II� II lu � I� II I� II ul u I� II u� �I ul (I �U I IU)
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Tra�c Signal Standard @ $5
Supplemental Fee @ $20
Transformers u to 10 KVA $10
Transformers over 10 KVA @$ 20
Transfortner / Power Su I for Si ns / Outline Li htin $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Addfional Inspection Tri $20
Investigative Fee
Reins ction Fee @ $20
TOTAL FEE s: e ..
(minimum total fee is $20)
THISAFiEA FOR AVSPECTOR USE ONLY
I hereby certi(y Nat I inspectetl the el�trical installadon described herein an the detes stat�:
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VECTED IF NOT COMPLETED WITHIN 12 MONTHS __ _____
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��' Rough-in Inspectfon Required7 ❑ Ye � No Inspection Other Than Rough-In: [}�teady Now �Wfil Call
$0 ����6 You must call the inspectar when readyl Date Ready.
I c�rtify that I am the L�I LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at