P - 75806REQUEST FOR ELECTRICAL INSPECTIO�
�� Q Z � � � O � � Minnesota Board of Electricity (��-- :
�_ � 1821 University Avenue Suite 5128, Saint Paul, Minnesota 551
�` (651) 642-0800 TIY/MRS 1-500-627-3529 www.elecfricity.state.mn.us
Describe -usirtg the back of the white coPY if necessary - the work cov�d by this request: �1 _
:UITS /
0 to 2(t
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S em Device or paratus @$.50
ADDI170NS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UN
3 to 12 Units @$50 Per Unit
Each Addidonal Unft C� $25
�LLATION MAY BE ORDERED I
II�) IIIII Illu II�I III�I IIIII IIIII ulll �� I�
L927202�
Transformers over 10 KVA $ Z(I
Transformer / Power Supply for Signs / Oudirre LI ' $5
ONE 8 TWO FAMILY DWELLINGS, EACH UNR
Includes the Service andlor Power Supply up to 500 Amper�, A�
Circuits and Two Ir�specUon Tdps Each Dwelling Unit @$80
Add�fonal Ir�snecUon Trios Cdt $20
I
TOTALFEE
total fee is $201
el�trlcal NsfaOatlai d�
JIPLETED VYITHIN 12
FOR OFFICE USE ONLY
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Rough-in Inspectlon Required7 ❑ Yes ��l�o Inspedlon � Rough-I�y Naw O WiA Call
'�� You must call the inspe�or when readyi � Date Ready. � I� �V�
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I certify tfiat I am CENSED CONTRACTOR ❑ COMPANY ❑ OdVNER and hereby request inspe�tion of Uie electrical work at
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Licen� Number
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