P - 75740REQUEST FOR ELECTRICAL INSPECTION ��
� � � � � Q, � 2 � Minnesota Board of Electricity ���— �} ��
1821 University Avenue Suite 5-128, Saint Paul, Minnes6ta'
(651)642-0800TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us 'u" "��
Describe -using the back of tha white copy'rf necessary - the work covered by this request:
�t �
GENERAL FEES Outdoor Lightirtg Standard @$1
SERVICES / POWER SUPPLIES Traffir. Sinnal Standarrl /`T G6 � �
� CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
�_ Each System Device orApparatus @$.50
ADDITIONS TO THE GENERAL I
2 Units @ $50 Per Unit
Add'iUonal Unit C� $25
CeMer
Transformers over 10 KVA $ 20 �' "
Transformer / Power Su I for Si rrc / Outlirte Li htin $5
ONE 8 TNIO FAMILY DWELLINGS, EACH UNIT
� Includ� the Service arid/or Power Supply up to 500 Amperes, All
�NALING Circuffs and Twro Inspection Trips Each Dwe�ing Unit @$80
Addfional Ins 'on Tri $20
Investl ative Fee
> Refns 'on F� $20
TOTALFEE r
(minimum total fee is $20) ! �
TF09 AREA FOR N6PEC(qi U� OM.Y
I hereby certlfy that I mspeded the electriwl i�talladon de�bed hereh� nn the dafes �ated:
ATION MAY BE ORDERED DI
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18204925
IF NOT
POP, GFF;CE USE UNL?'
12
"`w' I Rough-in InspecUon Required? �Yes ❑ No IrispecHon Other Than Rough-In: � Ready Now�Will Call
�� "�° �� You must call the inspector when ready! Date Ready.
I certify thffi I am the p LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Site Street Address ��
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Owner/O�up�t Neme Please Provide Two (2) Phone Numbers Induding Area Code
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WSTRUCTIONS ON BACK �� LLOW CO BpARO OF ELECTRICITV COPV co nnrm� n nc e