P - 76207REQUEST FOR ELECTRICAL INSPECTION � '
�������� � Minnesota Board of Electricitp H � � a oi,�
1821 University Avenue Suite 5-128, Safnt'Paul, Minnesota 55104
(651) 642-OS00 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us
Describe -using the back of the white copy'rf n - the wo ered by this requ�st:
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GENERAL FEES 0 oor Liahtinu Standard C� $1
I SERVICES / POWER SUPPLIES
CIRCUITS / FEEDERS
0 to Z00 Am ere a$5
Above 200 Am ere a$10
ALARM, COMMUNICATION, REMOTE CONTRO�
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
MULTIFAMILY DWELLINGS PEI
3 to 12 Units @$50 Per Unit
M811Uf3Ctuted
�ecial Inspection @ $30 er Hour
�ecial Ir�spection @ $.31 per Mile
INSTALLATION MAY BE ORDERED t
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215�2820
Transfortrters u to 10 KVA $10
Transformers over 10 KVA $ 20
Transfomrer / Power Su I for Si ns ! Outlirte ' htin $5
ONE 8 T1N0 FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, Ail
Circuits and Two Inspection Trips Each Dwelpm� Unit @$60
Additionallns 'onT' $20
Investigetive Fee
Reir�s 'on Fee $20
TOTAL FEE /��
(minimum total fee is $20) ( f
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I hereby certHy that I Nspeded the eledrical ir�teDatlon de�d hme6i on the dates steted:
) IF NOT COMPLETED WITHIN 12
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�� Rough-in Inspecdon R�Wred9 ❑ Yes �No Inspectlon Other Than Rough-In: ❑ Ready Now�Uill Call
Co� I `—�� You must call the inspedor when readyl Date Ready:
I cefify that I am the [S7LICENSED CONTRACTOR ❑ COMPANI' 0 OWNER and hereby request inspection of the electrical work at
Job S(te Street Address C(ly
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Contractor Number Master Electridan or Power Ltrnited TeGv
C P�Z �� Licer�se Numt�r
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Please Provide Two (2) Phone Numbers Including Area Cod
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