P - 76171REQUEST FOR ELECTRICAL INSPECTION
2� o e# �� 3� 1� Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.sdate.mn.us
De,�ribe -using th� dc of the white coPY if necesaary - the work covered by this requ�t:
� �.
ENERAL FEE Outdoor Lighting Standard @$1
SERVICES / POWER SUPPLIES Traffic Sianal Standard C� $5
0 to 200 Am ere (�D $Fl •�
Above 200 Am ere a$10
ALARM, CAMMUNICATION, REMOTE CONTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
3 to 12 Unrts @$50 Per Unft
Each Additional Unft CaD $25
Hour
Transfortners over 10 KVA $ 2(1
Transfortner / Pawer Suppiy for Signs / Outl'me LigMing @$5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Suppty up to 500 Amperes, All
Circuits and Two Inspection Trips Each DweWng Unit @$60
TOTALFEE
total f� is $201
25' S�
I msDecOed Ne elechical tr�ailallan dascaibed frerein on fhe dat� s�ted: I
12
FOR �FF10E USE QNLY
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20.46361� ��JV� ����I
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I certify that I am thi
Job Site Streat Addre
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Rough-in Inspec8on Requfred7 ❑Yes �`No Inspecdon Other Than Rough-In: dy Now �Wip CaA
You muat call the Mspedor when readyl T`/ Date Ready.
NSED CONTRACTOR ❑ COMPANY � OWNER and hereby �equest ins�ction of the electrical work at
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�se Number Mester Eledridan or Power Limited T�
��� (t LI�n� Num�r
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Please Provide Two (2) Phorte Numbers Inrduding Area G
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