P - 760421 7 8 7 0 6 7 6❑ REQUEST FOR ELECTRICAL INSPECTION
� � Minnesota Board of Electricity
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
� (651) 642-0800 TTYlMRS 1-800-627-3529 www.electricity.state.mn.us
Describe -us�°igthe back of the white copy if ne���ne ����py�q��t; S SW I TCH
GENERAL FEES Outdoor Liahtina Standard (�a $1
4Q0
Supplemental Fee I
Transformers up to
Transformers over
v re$10 Includes the Service and/or Power Supply up to 500 Amperes, All
IICATION, REMOTE CONTROL, SIGNALING Circufts and Two Inspection Trips Each Dwelling UnR @$BO
ITS OF LESS THAN 50 VOLTS Additional Ins ction Tri s $20
Device or Apparatus @$.50 Investigative Fee
�DITIONS TO THE GENERAL FEES Reinspection Fee @$20
ELLINGS PER UNI TOTAL FEE �O, 51�
�$50 Per Unit (minimum total fee is $20)
�1 Unit @$25 rxisa�avoa ousa�croa use orar
OTHER ADDITIONAL FEES
fit @$.25 pef FiXturB I hereby certity that I inspected ihe electrical installation d�cribed herein on the dates stated:
1 per Mile
I II� II III II lu II I� u UI II�� �� �I U�II II �II I Ilu
17870676
IF PIOT
������r�L�
l-2�— �
I"8��.�'ob Rough-inlnspec6onRequired? ❑Ye� $]No InspectionOtherThanRough-In: �(ReadyNow❑W(IlCall
You must call the inspector when readyl Date Ready:
I c�r tha� I em the L#1 LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspectian of the electrical work at
H7$TRUFilON3 ON BACK OF YELLOW COPY BOARD OF ELECTRICITV COPY FR-mmntn-�s n� �nnn