P - 76552REQUEST FOR ELECTRICAL INSPECTI� � ��
1�� V U- 8 5 4� Minnesota Board of ElecUicity '� �! ��'.�y4
1821 University Avenue Suite S-128, S int Paul, Minne�sota 55 4
(651) 642-0800 TTY/MRS 1-800�27-3529 www.electricity.state.mn.us
❑ NEW ❑ REMODEL ❑ ADDITION EPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
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GEN L FEES Outdoor l.iahtina Standard B$1
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or atus E.50
ADDITIONS TO THE GENERAL FEES
3 to 12 Units @ S50 Per Unit
Each Additional Unit @ E25
:5 Fixture
BOOrtI � LW
_ � Transfortners up to 10 KVA �$10
� Transformers over 10 KVA �$ 20
Transfomier / Power Supply fa Signs I Outline Liahtinu $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes ihe Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspectlon Trips Each Dwelling Unit �$80
Addi6onal Inspec6on Trips $20
investigative Fee
Reinsoec6on Fee Cd $20
(minimum total fee is $20) jJ �
rNisu�nFaanasaECTOausE r
1 he2by cer6fy that I inspetted the electrical installa6pn described herein on the d�es StaBed:
FEES
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ROUC�i IN arE
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FMNL NSPECipN `D/�iE �
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IF NOT COMPLETED WITHIN 12 MONTHS
II�I IIIII IIIII II III II III �I III IIIII II III �� I�I
15808546
"wu�'�e� Roug�-in Inspedipn Ftequirod? ❑ Yes ❑ No Inspection Other Than Rough-In: �Ready NoNy�Vyfll Call
�� /y �� You must call the inspectw when ready! Date Ready:
I certify that I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby req�st inspection of the elechical work at:
Job Sile Address (SVeeL Box. or Ftaute No.1 Citv ��., r,.we
ao� aF �c�wcm cc�r
masror r�ecmcian or
ucense rM,moer
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