P - 76084REQUEST FOR ELECTRICAL INSPECTION
�� 0 2� 7 3 7 � Minnesota Board of Electricity ;�
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
�� 3� (651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
D�ai� -usi the back of the white copy'rf necessary - the work covered by this requ�t:
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� FEEDERS rsnsformer I Povrer Su I for Si ns / Outline Li htin $5
10 Am re$5 � 0 Vi{OI 8 TWO FAMILY DWELLINGS, EACH UNIT
200 Am re$10 � Ir�cludes the Service andlor Power Supply up to 500 Amperes, �II
)MMUNICATION, REMOTE CONTROL, SIGNALING Circuits arid Two Inspection Trips Each Dwelting Unit @$60
CIRCUITS OF LESS THAN 50 VOLTS Additlonal Irts 'on Tri $20
� m Device or Ap s(a� $.50 Inves� ative Fee
ADDRIONS TO THE GENERAL FEES Reirs 'on Fee $20
ILY DWELLINGS PER UN TOTAL FEE 7�,
! Unils @$50 Per unit (minimum tota� fee is $20) �l�' �
1dd'itlonal Untt (� $25 '�"�"�'°�T0"'�0"°Y
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9 Retrofit @$25 per Fhdure I hsreby certlty mat I�ected the el�triml i�Vatlon desnmed h�em on tlre dams ammd:
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°(J�-, _��° You must call the inspector when readyl Date Ready.
I certify that I am the �ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby r�uest inspection of the ele�ctrical worlc at
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