P - 76629�
(� '�'% � REQUEST FOR ELECTRICAL INSPECTION ��=' '�
1� J"5 �� 1�� � Minnesota Board of Electricity �- �
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �'
R (651) 642-0800 TTY/MRS 1-800-627-3529 wwrv.eleclricity.state.mn.us
Describe usi g� the wh' copy if necessary j6e w�ed by this request:
//�
G L FEES Outdoor Lighting Standard (� $1
I SERVICES /
Above 200 Am ere a$1 Q
ALARM, COMMUNICATION, REMOTE CANTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aooaratus C� $.50
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Lighting Retrofit @ $.25 per Fixture
Center Pivot Imaation Boom an $40
Traffic Siqnal Standard
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspec6on Trips Each Dwelling Unit @$80
Additional Inspection Trips @ $20
Investiqative Fee
total fee is $20)!b'v '
I hereby certiy lhal I inspected the electrical inslallation described herein an the dates stated: �
Se arate Bondin Ins ion $20 � � — /L . / ` - 6�
S CC181 IOSpBCtiOn $30 p@f HOUf exaiReoinanNOONeo pArE
S 'al Inspection $.31 per Mile
_ THIS INSTAlLAT10N MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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i l l l l I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I �, r. �<
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uace:�/�, /�� Rough-in Inspection Required? ❑Ye� Inspection Other
lif'
�,K You must call the inspector when ready! Date Ready: G
I certi(y that I am th CENSED CONTRACTOR ❑ COMPANY ❑ OWNER and heret
Jo��St Address ' ��/� � I� •
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lectrical
Name
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actor, C mp y or Ow er Performing
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❑ Wilt Call
inspectiqn of the electrical work at:
Master ElecUician or
License Number
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