P - 76150REQUEST FOR ELECTRICAL INSPECTION
2� 0��� 6 6�� ��nnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
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f (651) 642-0800 TlY/MRS 1-800-627-3529 www.elecri-icity.state.mn.zrs
�cribe -using the ack of the white copy H n�essary - the work covered by this request:
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GENERAL FEES Outdoor Liahtirm Standard C�D $1
Above 800 Am ere $75
CIRCUITS / FEEDERS
0 to 200 Am ere a$5
Above 200 Am re $10
ALARM, COMMUNICATION, REMOTE CONTROI
CIRCUITS, CIRCURS OF LESS THAN 50 VOLTS
3 to 12 Units C� $50 Per Unit
Hour
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20326682
Transformers over 10 KVA $ 20
Transfortner / Power Supply for Signs / OuUine Lightir�g @$5
ONE 81W0 FAMILY DWELLINGS, EACH UNIT
Includes the Servtce andlor Power Supply up to 500 Amper�s, All
Circuits and Two Inspecbon Tdps Each Dwening Unit @$80
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total fee is $20) �� sa
I herebvi certliv that I tr�speded tlre el�tricel msfa0atlon des�ed here6i on tlre dates affied: I
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��� Rough-in Inspectlon Requiredl ❑ Yea o InspecUon Ofher Than Rough-In: ❑ Ready New�11 Call
o— ��-a You must call the inspedor when readyl Date Ready.
I certify that I am the�CENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby r�uest inspectian of the electrical work at
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66 � /y� I License Number
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