P - 76103p REQUEST FOR ELECTRICAL INSPECTION �
1� 1 v�- 0 4 6 0� Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
Describa -�ing the back of the white copy'rf ne�capF,ihe v�rk �cg�dby�i��t: ��� jCH
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°� � GENERAL FEES Outdoor Liqhtinq Standard (�a $1
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tWIMUNICATION, REMOTE CANTROL, SIGNALING
CfRCUffS OF LESS THAN 50 VOLTS
3YStem Qevice or Apparatus na. $.50
Transformers u to 10 KVA $10
Transformers over 10 KVA $ 20
Transformer I Power Su I for Si ns / Outline Li htln $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unft @$80
Additional Ins ction Tri $20
Investigative Fee
Reinspection Fee @ �20
TOTAL FEE ^Ln, 5(j
(minimum total fee is $20)
TFIISAF�AFOA NSPECTOR USE OiRY
I hereby certity that I inspected the electrical instellatlon described herein on the dates sfeted:
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peaai Ins ' n@$.31 per Mile
Tk11S INSTALLATION AAAY BE ORQERED DISCONNECTED IF NOT COMPLETED WITHIN 12
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�' Rough-In Inspectlon Required7 ❑ Ye �] No Inspection OtherThan Rough-In: [�Ready Now �Will Call
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You must call [he inspector when readyl Date Ready.
l s�r�jr �at 1 am the C�J LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
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MaiEjng Address (Co
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Range
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Please Provide Two (2) Phone Numbers
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Area
e Contrector License Number Master Electricien or Power Limited l
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r, Company or Ovmer Perfortning Installadon)
D�,IAL RO�Dq SAIMT F'�UL9 hlhf �51i�
ntractor or Owner Pertortning Installation) Please Provide Txro (2) Phone Numbers Including Area
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