P - 77207REQUEST FOR ELECTRICAL INSPECTION
1— 7 31 � 14 0� Minnesota Board of Electricily
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651)642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
0 NEW ❑ REMODEL ❑ ADDITION REPAIR Describe -using the back of Me white copy if necessary - the work covered by his request:
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�ENERAL F S Outdoor Liahtina Standard (d $1
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
to 12 Units ca $50 Per Unit
ach Addi6onal Unit @ $25
Hour
Mile
uil il�l� i! li! II lil I!!'! il III II ill II III pl� i�l
1 7 3 1 1 4 0'
Transformers u to 10 KVA $10
Transformers over 10 KVA �$ 20
Transformer I Power Supply for Signs / Outline Ligh6ng @$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Suppiy up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additional Inspection Trips @ $20
Investiga6ve Fee
ReinsDection Fee (�a $20 d
TOTALFEE
(minimum total fee is $20) ��� s �
iH15 AREA fOR INSPECiOR USE 0llY
I hereby certify that I inspected the elecOrical install�on described herein on the dates stated:
ISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS _ I
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ecequesi va[e: Rough-in Inspection Required? LJ Yes iCJ No Inspection Other Than Rough-In: �eady Now ❑ Will Call
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You must call the inspector when ready! Date Ready: y�
I cerMy that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and her�by request inspection of the electrical work at:
Job Site Address (Street, Box, w Route No.) =City Zip Code
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ON BACK OF VELLOW COPY
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ddress
ConVador License Number Master Electridan a Power Limited Techn
License Number
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Ilation) Phone (s)
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ELECTRICITY COPY EB-OOOOtA-14 8.1.