P - 760221��� 0�� � REQUEST FOR ELECTRICAL INSPECTION
� � Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-OS00 TTY/MRS 1-800-627-3529 www.edectricity.stale.mn.us '
De�cr'tbe -using the back of the white copy if ne���ne ����y�,���t; S S4J I TCH
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CIRCUITS OF LESS THAN 50 VOLTS
�ystem Device or Apparatus @ $.50
ADDITtONS TO THE GENERAL FEES
3to12
Traffic Sianal Standard
Transformer / Power Su I far Si ns / Outline Li htl $5
ONE & TWO FAMILY DWELLINGS, EACH UNR
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unft @$80
Additional Ins ctlon Tri $20
Investigative Fee
Reins ction Fee @ $20
TOTAL FEE ^,L(j, �{j
(minimum total fee is $20)
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I hereby certiry that I inspecled the elechical InstallaGon described herein on the detes stat�i:
� WST�ALLATION MAY BE ORDERED DISCONNE�
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IOT COMPLETED WITHIN 12 MONTHS ___
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A�' Raugh-in Inspection Requlred? ❑Ye �] No Inspection OtherThan Rough-In: [�Ready Now ❑Will Call
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You must call the inspector when ready! Date Ready:
I e�y that I am the I� LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work afi
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Please Provide Two (2) Phone Numbers Inciuding Area Code
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