P - 75870I Z�� ���� �: REQUEST FOR ELECTRICAL INSPECTION
� � � Minnesota Board of Electricity
1821 Universilyr Avenue Suite S-128, Saint Paul, Minnesota 55104
, (651) 642-0800 T'fYlMRS 1-800-627-3529 www.edectrici6y.stade.mn.us
Desaibe -usim� the back of the white copy'rf necessary - the xrork covered by this request: ���^ ` O�/p�
V� (
I SERVICES / POWER
0 to 200 Am�ere $5
Above 200 Am �ere � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGI
CIRCUITS, CIRCURS OF LESS THAN 50 VOLTS
Each S em Device or A paraWs @$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAPAILY DWELLINGS PER UN
3 to 12 Units @$50 Per Unit
Each Addi�onal Unft (o� $25
Sit�s
1ATION MAY BE ORDERED DI
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18232538
Outdoor Liahtirta Sfandard
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includac the Service and/or Power Suppty up to 500 Amperes, All
Ciratits and Tuvo Inspedion Trips Each Dwellmg UnR @$80
Addi�onal Ins 'on Tri $20
Imesti ative Fee
Reins 'on F� @ $ZO
TOTALFEE
(minimum total fee is $20)
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I irereby certlfy tlmt I Uispeded the etechicat Installa8on desafbed herein on fhe dafes
APLETED WITHIN 12 MONTHS
FOk qF�1t:E USE fJNLY
"a`a' Rough-in Inspecdon Required? ❑ Yes No Inspecdon Other Than Rough-In: ❑ Ready N WIA Call
�Q �� �� You must cell the inspector when readyl Da6e Ready.
I cerMy I am LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby r�uest inspection of the electrical work at
Job Site Street Address Cgy
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