P - 75458a q REQUEST FOR ELECTRICAL INSPECTION „ , ,
1� O 2�°�7, 5 0 � Minnesota Board of Elecficity
1821 University Avenue Suite S-128, Saint Paul, Minnesrota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
Desaibe -using the badc5f the white wpy'rf ne�sary - the xrork covered by this ra�u�t:
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GENERAL FEES Outd�r Liahdrm Standard (d $1
401 to 800
Above 800
CIRCURS OF LESS THAN 50 VOLTS
MULTIFAMILY DWELLINGS PEI
3 to 12 Units C� $50 Per Unit
Hwr
� ranstormers wer iu Kv,a ro� zu
Transformer / Power Su I for Si s/ Outline LI hti $5
ONE & 11M0 FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 5Q0 Amperes, All
Circ�its and Two Inspection Trips Eech Dwelling Unit @$80
Addidonal Ins 'on Tri $20
Inv�sti e Fe.a
Reins on Fee $20
TOTAL FEE �y� . � �
(minimum total fee is $20) 6
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I hereby certlfy fimt I 6�d the elerfiical installadan dene�bed herein on tlre datea sleted:
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f'OR OFFECE USE ON�Y
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��� Rough-in Ins�Ction RequUed9 ❑Yes ❑ No Inspection Other Than Rough-In: 0 Ready Now �W�l CeII
(��� ��� You muat caU the inapedor when readyl Date Ready:
I cerBty that I am the � UCENSED CONTRACTOR ❑ COMPANY � OWNER. and hereby request inspection of the electrical work at
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�e Number Master Electridan or P
ticense Number
Plea� Provfde Two (2) Phone Numbers I
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