P - 758581 � � � �� � � � REQUEST FOR ELECTRICAL INSPECTION .:
w e� � Minnesota Board of Electricity _1.
���A �� 1829 University Avenue Suite S-128, Saint Paul, Minnesota 55104
PJ (65a) 642-0800 TTY/MRS 1-500-627-3529 www.electricity.state.mn.z�r
Descdbe -using the back of the w capy if necessary - the work cover� by this request:
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GEN FEES Outdoor Unhtina Standard (�a $1
CIRCURS/fEEDERS
0 to 200 Am re $5 trYl °
A�ve 200 Am ere �$10
ALARM, COMMUNICATION, REMOTE CONTROL, SIG
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Davice or Apparatus @$.50
ADDI770NS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UN
3 to 12 Units @$50 Per Unit
Each Additional Unft f�a $25
Retrofit
Sftes
Transformers over 10 KVA $ ZO
Transfomrer / Power Su I for Si ns / Outlirre Li ' $5
E 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Addibonal Ins 'on T $20
Investl ative Fee
Reins 'on Fee @ $20
TOTALFEE
(minimum tatal fee is $20) ����
TXIS AflFA FOR PE&ECfON USE Q�LLY
I hereby ceAiTy that I inspeded the eledrical trre�iledon d� harein on fhe detes stated:
1LLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WRHIN 12
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g pecdon Requlred? ❑ Yes No Inspecfion Other Than Rough-In: � Ready Now Ca�
��� v� You must call the inspedor when readyl Date Ready.
I certify that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request insp�Gon af the electrical work at
Job Site Street Address n `
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Anoka. MN
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Llcer�se Number
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or er P rmirtg Instanatl Please Provide Two (2) Phmre Numbeis Including Area Cade
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