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❑ NEW ❑ REMODEL DDITION ❑
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GENERALFEES
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.electriciry.state.mn. us
� Describe -using the back of the white copy if necessary - the work covered by th�is reguest
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Outdoor Liqhtinu Standard � $1
800 Am a50 Transiormers u to 10 KVA $10
800 Am re $75 Transfortners over 10 KVA $ 20
FEEDERS Transformer I Power Su I for Si ns / Outline Li htin $5
0 Am re $5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
200 Am re $10 Includes the Service andlor Power Supply up to 500 Amperes, All
MMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Tnps Each Dwelling Unit @$80
CIRCUITS OF LESS THAN 50 VOLTS
>vstem Device or Aooaratus (d 5.50
3 to 12 Unils
Each AddiGoi
Hour
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17261199
Reins 6on Fee $20
TOTAL FEE � b"'a
(minimum total fee is $20) -�'
TMIS AREA FOR INSPECiCQ USE IXJIV
I hereby cer6y that I inspected the electrical installa6on described herein on the dales stated:
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Request ua�e: �,Rough-in Inspection Required? �4es ❑ Np Inspedion Other Than Rough-In: ❑Ready Now Will Call
� �� I�' �� I You must call the inspectw when ready! Date Ready:
I certi(y that I am the �LICENSED CONTRACTOR 0 COMPANY ❑ OWNER and hereby request inspection of the electrical work at::
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� Power Supplier Address
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ddress (Contractor, Company or Own� Performing Instellffiion)
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ON BACK OF
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�r ucense rvumoer nnaster r�eclripan a Power Limited Technician
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BOARD OF ELECTRICITV COPV EB•00001M74 8.1. 2002