P - 75228REQUEST FOR ELECTRICA INSP CTION
� ��`� � � � � � � Minnesota Board of Electricity � � � ��a
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-500-627-3529 ity.state.
�'be -usir�g the back of the white copy'rf �ssary - rk covered by this request:
l� r,�,.� � � I ��. � v� ��.� _ �—A-1 vu�.l�
Above 800 Ampen
:URS/FEEDERS
0 to 200 Amoere U
)MMUNICATION, REMOTE CONTROL, SIGNALING
CIRCURS OF LESS THAN 50 VOLTS
Transfortners u to 10 KVA $70
Transformers over 10 KVA @$ 20
Transformer / Power Supply for Signs / Outline Lightirm @$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includ� the Service and/or Power Supply up to 500 Amper�s, All
Circutts and Two Inspection Trips Each DwelBng Unit �$80
3 to 12 unns @$50 Per Unit (minimum total fee is $20)
Each Additionel Unit @ $25 /�N g-/S•6� ���auarECr�usEa�o.r
OTHER ADDffIONAL FEES
LiUhUna Reh'offi aC2 $.25 Der FocduB I hereby cmdry tlrat I in�d tlre els�ic�l h�sta0atlon described Irerein on
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21276829
ED IF NOT COMPLETED WITHIN 12 I
REC'D M��F������007
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�: Rough-in InspecUon Required? ❑ Yes �to Inspectlon Ofher Tt�an Rough-In: ❑ Ready Now � CaA
���'�o You must ceU tfte Irispector when ready! Date Ready:
I certiffy that I am the LICENSED COMRACTOR O COMPANY ❑ OVVNER and hereby requ�t insp�tion of the eledrical work at
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ise Number Master Eiectric�n or P
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Pleas Provide Two (2) Pho�re Numbe�s
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