P - 78381REQUEST FOR ELECTRICAL INSPECTION
1,� 4 5'8 � 5 2 O � Minnesota Board of Electriciiy -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTYIMRS 1-800-627-3529 www.electriciry.state.mn.us
❑ NEW ❑ REMODEL ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
P��d �} D D � r�on% - �.
GENERAL FEES Outdoor Li hfin Standard $1
SFRVIf.FC I P(1WFR SI IPPI IFS Traffic Sianal Standard Ca? $5
401 to 800
Above 800
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCUITS, CIRCUITS Of LESS THAN 50 VOLTS
Each S stem Device or A aratus $.50
ADDITIONS TO THE GENERAL F
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
FiX1UB
Transfortners over 10 KVA $ 20
Tr�sformer / Power Suppty for Signs I OuUine Liqhting @ a5
ONE 8 TWO FAMILY DWELUNGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Cirouits and Two Inspection Trips Each Dwellirg Unit �$60
iviw�.rtt
(minimum total fee is $20) �� �
TMS AREA Fpi MSPECTOR USE IX1V
I hereby caAify tl�at I inspecfed the etettrical installa6on described herein on tlie da�s st�ed:
THIS INSTALLATION MAY BE ORDERED DISCONNE
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Request Date: Rough-in Inspection Required? ❑ Yes �No tnspedian Other Than Rough-In: ady Now ❑ VYdI Call
g�Z�j �Q � You must call the inspedor when readyl Date Ready: _
I certi(y ihat I am tt�e �ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and he�eby request inspection of tlie electrical wak a�:
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3 0 4 5 g Please Provide 7wo (2) Phone Number(s
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Power Supplier Address
ConVactor License Number Master Electricien or P
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BOARD OF ELEC7RICITY COPY
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