P - 75690REQUEST FOR ELECTRICAL INSPECTION
2-o d��.� 16 � Minnesota Board of Electricity
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.edectricity.state.mq.us
Desaibe -usmg the back of the white co y'rf necessary - the work covered by this r�uest:
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GENERAL FEES Outdoor Lighting Standard @$1
Above 800 Am ere a$75
CIRCUITS / FEEDERS
0 to 200 Am re$5
Above Z00 Am re $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
3 to 12 Units @$5D Pe
Each Addrtional Unit @
Fodure
IIII II �I II �I � I� II I�I II I!I II III II III Q� I�
20701165
Transformers u to 10 KVA $10
Transformers over 10 KVA @$ ZO
Transformer / Power Supply for Signs / Oulline Liqhting @$5
ONE & NVO FAMILY DWELLINGS, EACH UNR
Includes the Service and/or Power Supply up to 500 Amperes, AII
Cirarits and Two Inspection Trips Each Dwelling Unit @$80
TOTALFEE
(minimum total fee is $20) � � S'�j
TFbR Af�A F� P1�ECf OR U� Q�LLY
I hereby certlfy that I inspeded the electricel h�lladon descnbed herein on tlre daf� siated:
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!CTED IF NOT COMPLETED WITHIN 12 MONTHS
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�� Rough-in Inspecdon Required7 ❑Yes�Ro Inspedion OtherThan Rough-in: ❑ Ready Now�'Call
You must cell the inspedor when readyl Date Ready:
I certdy that I am the �CENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby r�uest ins�ction of the electrical work at
Job Site Street Addres Cily
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License Number
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ide Two (2) Phorre Numbers
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