P - 76196p� REQUEST FOR ELECTRICAL INSPECTION ���� .
��� 2�•�� � 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.elecMicity.state.mn.us � ' `� .
i � ng t��ck o� hite copy'rf ry- the w� covered by this req� � �� '�c
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GENE FEES Outdoor Liahtina Stan id $1
to 400
CIRCURS OF LESS THAN 50 VOLTS
iystem Device or Apparatus @ $.50
ADDITIONS TO THE GENERAL FEES
Unit @
Pivot
INSTALLATION MAY BE ORDERED DISCON
I IIII II �I II I� I� lil II III (� �I � III II
18202 4 ��
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I Transformers up to 10 KVA $10
J Transtormers over 10 KVA @$ 20
� Transfortner / Power Supply for Signs / Outline Li htin $�
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Cir�uits and Two Inspeclion Trips Each Dwelling Unit @$8
(minimum total fee is $20) D � � -�
nas a�a wa wsvECroa usE a�o.v
(c9sh� �r��j., S =zz�?
I hereby certify that I hispea� the electrinl trrsta0atlon des�aibed herein on ttre datea ate�:
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,� ` � Rough-in I on Req ? Yes ❑ No = Inspectlon Other Than Rough-In: 0 Ready Now yyWiO CaII
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You must call the i or when r dyl Date Ready.
I certify that I am the LICENSED CONTI�CTOR 0 COMPqNY ❑ ONfNER and hereby request inspection of the electrical work at
Job Site Street C
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T P SecUon Range Fire No. Cou
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Please Provide Two (2) Phone Numbers Inctudirtg Area Code
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mascer rrecmqan or
License Number
or or Owne� Pertormin§ Instal(atloF'J' "� '� p� provide Two (2) Phone Numbers I
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)W BOARD OF ELECTRICITY C(TPV