P - 75749REQUEST FOR ELECTRICAL INSPECTION
1�24 4 4 � Minnesota Board of Electricity ���. ,��C
� � 1821 University Avenue Suite S-128, S" t au , mn �ta`5$1(�r�
� — � � (651) 642-0800 TTY/MRS 1-500-627-3529 www.electricity.state.mn.us
Desa(� -using the back of.the white copy'rf na�ssary - work ered by this � "
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GENERAL FEES Outdoor Liuhtina Standard fa� $1
0 to 200 Am ere (�D $5
Above Z00 Am ere ¢ $10
ALARM, COMMUNICATION, REMOTE COPITROL
CIRCURS, CIRCUITS OF LESS THAN 50 VOLTS
to 12 unfts
Parlc Lots
.LATION NFAY BE ORDERED [
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19U24447
Transformers u to 10 KVA $10
Transfomrers over 10 KVA @$ ZO
Transformer / Power Suppty for Signs / Outline Lighting Q$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includ� the Service and/or Power Supply up to 500 Amperes, All
Ciratits and Two InspecUon Trips Each DvrelGng Unit @$60
Fee a $20
TOTALFEE
iimum total fee is $ZO) A� ��
I hersby certlfy thet I inspected tlre alechical mstella8on des�i�d herein on tlte dates st�d:
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IF IdOT
I"OR Osr-ICE usE �Ni.v
12 MONTHS
"a�' Rough-in Inspectlon R�uired7 ❑ Yes No Inspedion OTher Than Rough-In: Ready Now O WIII Cap
���v You must call the inspector when read Da6s Ready:
I certify that I am the LICENSED COMRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical xrork at
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3.t` I{� �ntractor or �Owner P�rfortn nste
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1aster Electrician or Power Limited Techni
laense Number
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o u bers Including Area Code
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