P - 75879REQUEST FOR ELECTRICAL INSPECTION
�� � � � � a � � � Minnesota Board of Electricity
1821 University Avenue Suite S-128, S' aul, Minnesota 55104
(651) 642-0800 TTY/MRS 1� .elecMcity.state.mn.vs
Desaibe -using the back of the whtte�copy if necessary - ihe work cover� is r�u
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Above 200 Am ere $10
ALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S m Device or s@$.50
ADDITIONS TO THE GENERAL I
MULTIFAMILY DVdELLINGS PER UN
3 to 12 Units Q$50 Per Unit
Each Additlonal Un(t C�B S25
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Traffic Si rcal Standard @ $5
Su lemerdal Fee @ $20
Transformers u to 10 KVA $10
Transfomrers over 10 KVA $ 20
Transformer / Power S I for Si ns / Outline Li htln $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Ir�cludes the Service and/or Power Supply up to 500 Amperes, All
Cirqrits and Txro Ir�spection Trips Each DwelGng Unit �$80
Add�tlonal Ins on Tri $20
Investlgative Fee
Reins 'on Fee $20
TOTAL FEE � �
(minimum total fee is $20)
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I hereby certHy tl�at I 6ispeaed ihe elec�trical h�sfaVadon desm'bed herein on ifre datea �ated:
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TFiIS INSTALLATION MAY BE ORDERED QISCONNECTED 1F NOT COMPLETED WITHIN 12 MONTHS
FOR OFFICE USE ONLY
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� g spectlon Required9 ❑ Yes No Inspectlon Other Than Rough-In: y Idow � Wip Cap
You must call fhe inspector when readyl Dale Ready.
I certify that I am the� LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER artd hereby request inspection of the electrical work at
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mascer r�ecmaan or
Ucense Plumber
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