P - 76345` � - REQUEST FOR ELECTRICAL INSPECTION , / �'
� � � � � � � 7 � � Minnesota Board of Electriciry V
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.elech~icity.state.mra.us
Descnbe -using the badc of the whfte copy iF r�ecessary - the wark covered by this request:
l� I� A�5� CL � t4D� �iitc�ci� �A�Z gA�eas`r �Rl-l�
GENERAL FEES Outdoor Liphtlmi Standard (6D $1
Above 800 Am re$75 Transfortners over 10 KVA $ 20
,UITS / FEEDERS Transformer / Posrer Su I for Si ns / OuUine Li htin $5
0 to 200 Am re $5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re$10 Includes the Service andlor Power Supply up to 500 Amperes, All
tM. COMMUNICATION. REMOTE CONTROL. SIGNALING Circuits and Two Insp�on Trips Each DwelGng Unit (a� $BO
CIRCUITS OF LESS THAN 5D VOLTS
MULTIFAMILY DWELLINGS PEI
3 to 12 Units a(Z $50 Per Unit
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� THIS INSTALLATION MAY BE ORDERED [
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18202770
Reins 'on Fee $20
TOTAL FEE �"^ ' �
(minimum total fee is $20) (J
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I frereby certtty that I Inspeded the eledrical iristelletlon d�saibed hazein on the dat� atat�:
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��� j Rough-in Inspedion Required? ❑ Yes ❑ No Inspec�on OtherThan Rough-In: ❑ Ready Now�Nlill Call
� Gc�/p�i % You must call the h�spedor when readyl Date Ready.
I certity that I am th�LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
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/ c:ompany Name Contractor License Number Master Dectridan or Power Ltrnl[ed TechNdan
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d�re.gqa (Contrador, Cpm �� er Performirtg Insfallatlon)
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d Sig Co r Perfortning Instelletion) Plea� Provlde Two (2) Phorre Numbers Includi� Area Code
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