P - 75454REQUEST FOR .. �rttICAL INSPECTION
�„� 2 0� 2� 3 � Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnasota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.eleciriclty.state.mn.us
Describe -using the badc of the white copy ff necessary - the aroric covered by this requ�t: .� �
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GENERAL FEES Outdoor Liahtirm Standard id 51
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;UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Uevice or Apparams @$.50
ADDRIONS TO THE GENERAL I
TIFAMILY DWELLINGS (PER UNI'1�
3 to 12 Unds CrD $50 Per Unit
i Home Park Lots
Vehicle Park Sft�
� THIS INSTALLATION MAY BE ORDERED DISCC
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Transformers over 10 KVA $ 20
Transformer / Power Supply for Signs / Outline Lighting @$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Inctudes the Service andlor Power Supply up W 500 Amperes, AO
Circuits and Two Inspe�.fion Trips Each Dwelimg Unit @$80
Addfional Ir�s ecUon Tri s,$20
Imestlgative Ftre
Reins ectlon Fee a $2(I
TOTALFEE
(minimum total fee is $20) �
nus aaea wa o�svECma usE a�ar
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I hereby certity fhat I inspeded tlre elec6lcal insfalla8on desaibed on tl�e
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FQP, t}FFICE USE (?ItiLY
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�� Rough-in Inspaction Requfr�7 ❑Yes ❑No Inspectlon OtherThan Rough-In: � Ready Now �WN Cap
You must cell the inspedor afien ready! Date Ready.
I certify that I am the ❑ LICENSED COMRACTOR ❑ COMPANY OWNER and hereby requast inspection of the eledrical work at
Job Site Street Addr�s Ciry
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P� Provide Two (2) Phorre Numbers Includ(ng Are
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ise rvumber master t�ecmdan or Nower umrcea i ecmt
IJcerise Number
Please Provide Two (2) Phone Numbers Induding Area Code
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