P - 76432REQUEST FOR ELECTRICAL INSPECTION �
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� � ❑ Minnesota Board of Electricity �r�-
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651)642-0800TTY(MRS 1-800-627-3529 x»��e.eleclricitv.s/ale.rnn.trs
Descnbe -using the back of the white copy if ne��,sg�r� :the y�9rk�.o,ye�.ed,by �i�s ��qU�.st; _.. _. _
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. GENERAL FEES Outdoor Liohtina Standard (� $1
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Above 200 Am ere $10 �
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CtRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Apparatus na $.50
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Lahtinp Retrofit (� $.25 oer Fixture
o� $20
Hour
Traffic Signal Standard
Supplemental Fee @ $
Transformers uo to 10
� Transformer I Power Supply for Signs / Outline Lighting @$5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additional Inspection Tnps @ $20
Investiaative Fee
TOTAL FEE I �?r, , _,; ;
minimum total fee is $20)
THIS AREA FOR INSPECTOR USE ONLY
�hat I inspected the electrical installation described herein on the dates slated:
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THi$ t#ISTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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f �a�' � I Rou h-in Ins ection Re uired? ❑Yes .
g p q .�[] No �' Inspection Other Than Rough-In: �Ready Now ❑ Will Call
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I You must call the inspector when ready! ��,,' Date Ready:
I certify that I am the LJ LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
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Range I Fire No. I County
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Owner/OcclipaM Name , Please Provide Two (2) Phone Numbers Including Area Code
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Elac4rical UtiNty Electrical Utility Address
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'� CO t arn dor / Company Name � �� Contractor License Number Master Electrician or Power Limited Technician
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'' �dailing Address (Contrector, Company or Owner Performing Installation) -
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'; Au�h4rg�d $' nature (Conhactor or Owner Performing Installation) PI sae e Provide Two (2) Phone Numbers Including Area Code
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