P - 756952 O�� O�J 5�' REQUEST FOR ELECTRICAL INSPECTION ��°' �,_
� � ❑ Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
� (651) 642-0800 T'fY/MRS 1-500-627-3529 www.electricity.stute.mn.ur
;D�esai� -using e ck of the wh;te copy'rf necessary - the work covered by this ra�uest:
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Standard
0 to 400
401 to 8i
0 to 200 Am re $5 ONE & NVO FAMILY DWEWNGS, EACH UNIT
Atmve 2�0 Am re$70 Includes the Service and/or Power Suppty up to 500 Amperes, All
RM, COMMUNICATION, REMOTE CANTROL, SIGNALING CircuiGs and Tvro I�p�on Trips Each Dwe�mg Unit @$80
:UITS, CIRCURS OF LESS THAN 50 VOLTS Additlonal Ins on Tri $20
Each S em bevice orA ratus @$.50 Investigative Fee
/iDDITIONS TO THE GENERAL FEES Reins 'on F� $20
.TIFAMILY DWELLINGS ER UN TOTAL FEE
3 to 12 Units @$50 Per Unit (minimum total fee is $20) ��
EaCh Additlor�al Unit Q $25 ,wsnr�n�uu�craiu¢oear
OTHERADDffIONAL FEES
LiaMina Retrofit [�D $.Z5 �r Fature I herebv c�rtiNthat I� the electrica� ir�tanation d�'bed hermn on tlie dams smmd:
Hour
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FQP, OF FIl�E !i�� ONL1'
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�� �e, Rough-in Inspection RequU�i7 ❑Yes No Inspedion OUrer Than Rough-In: 0 Ready Now WfA CaII
`Z— � 1 \��%l� You must call the inspector when ready! Da[e Ready:
I certify that I am the �ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby reque.st inspection of the electrical work at
Ja� S� Address ��� � � � City � �
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Township Secdon Range Flre No. Coupty
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�ta11aN Please Provide Two (2) Phone Numbers Including Area Code
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