P - 75993REQUEST FOR ELECTRICAL INSPECTION � �
2_ o J�' ° C� 0 3 � 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
D�scribe -u�ing the back of e white copy'rf necessary ;Ihe work covered by this request:
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GENE FEES Outdoor Lighting Standard @$1
SERVICES / POWER SUPPLIES ._ Traffic Sianal Standard C� $5
0 to 400
iM, COMMUNICATION, REMOTE CONTROL, SIGNALING
.URS, CIRCURS OF LESS THAN 50 VOLTS
Each System bevice or paratus @$.50
ADDITIONS TO THE GENERAL FEES
fIFAMILY DWELLINGS PER UN
3 to 12 Units id $50 Per Unit
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I IIII I� III II ��I II III II II� II I� II III I) III ��(�
�Q576039
Transformers to 10 KVA �10
Transformers over 10 KVA $ ZO
Transformer / Power Su I for Si ns / Outline Li $5
ONE & TWO FAMILY DWEWNGS, EACH UNR
Includes the Service andlor Poarer Supply up ro 500 Amperes, All
Cirt�its and Two Ir�spection Trips Each Dwelling Unit @$80
Add(tional I� 'on Td $20
Investlgative Fee
Reins on Fee @ $20
TOTAL FEE t.
(minimum total fee is $20)
ntis a�a r� wsvECroa usE owx
I herebY certifY that I fis�d fhe elechicel installeation d� herein on tlre dafes sfeted:
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�OR t1FFICE USE 6h;Lv
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1d1i' Rough-in InspecUon R uired? ❑Yes ❑No Ins
�eq pectlon Other Then Rough-In: y Now ❑ Wi� Cap
��•�� You must call the inspec[or when ready! Date Ready:
I certify that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Site Street Add �{ty
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�EPEi��A�LE ELECTRIC� INC.
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� Num� Master Electrician ur
License Number
Please Provide Two (2) Phorre Numben
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