P - 76315'' � ,r�� � � � � • REQU�ST FOR ELECTRICAL INSPECTION
� � � Minnesota Board of Electricity
1821 Universiiy Avenue Suite S-128, SaiM Paul, Minnesota 55104
• (651) 642-0800 TTYlMRS 1-800-627-3529 www.electricity.state.mn.us
- sing the ba of the white copy ff necessary - the work covered by this r�uest:
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ENERAL FEES Outd�r Lighting Standaid @$1
SERVICES / POWER SUPPUES TrafHc Sianal Standard (a� $5
Above 200 Am ere $10"
ALARM, COMMUNICATION, REMOTE CANTROL
CIRCUITS, CIRCURS OF LESS THAN 50 VOLTS
3 to 12 Units @$50 Per Unit
Each Add'�lonal Unit @ $25
OTHER AD
Liuhtlnn ReVofit C� $.25 oer F
Transfortners over 70 KVA $ 20
Transformer I Power Su I for Si ns / Outiine Li h' $5
ONE & TWO FAMILY DWELLINGS, EACH UNR
Includes the Service andlor Power Supply up to 500 Am�res, All
Circuits and Two Irrspe�.fion Trips Each Dwelling Unit @$80
Add'Rional Ins 'on Tri $20
Imesfigative Fe.e
Reins 'on Fee @ $20
TOTAL FEE
(minimum total fee is $20)
7XL4 AI�A FOR NL�ELTOFI
I herebvi certHv that I insoecded the eledricel h�stallatlon descnbed here6i on fhe datas atated:
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,t i eTIQN MAY BE-ORDERED DISCONN�CTED IF NOT COMPLETED WITHIN 92
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��� Rough-in Inspection R uir�7 ❑Yes No Ins
eq pedion Other Than Raugh-In: � Ready Now �ViO CeII
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You must call the inspedor when readyl Date Ready:
Fc�rtiiy that i am the �ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request ins�ction oFthe electrical work at
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MN 55433
or Ownar Perfom
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Please Provlde Tv/o (2) Phone Numbers Including Are
�T�i� �,�7947(�'�S/�.-•.
�se Number Master Electrician ur Power Limited
� �/) / License Number
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Please Provide Two (2) Phone Num6ers Includtr�g Are
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