P - 75226REQUEST FOR ELECTRICAL INSPECTION
2� o���� 1� � Minnesota Board of Electricity
1821 Unive ity Avenue Suite 5-128, Sairrt Paul, Minnesota 55104
(651) TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
Describe -usir�g the back of the white copy'rf necessary - th w by this request:
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GENERAL FEES Outdoor Liahtirm Standard (�a. $1
401 to 800
Atmve 800
�URS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDRIONS TO THE GENERAL
fIFAMILY DWELLINGS (PER UNIn
3 to 12 Units id $50 Per Unit
Manuhactur� Hame Park Lots f
Reaeatlonal Vehicle Park Sites
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Transformers over 10 KVA $ 20
Transformer / Powrer Supply for Sigr�s / Outline Lighdng (¢� $5
ONE & TWO FAMILY DWELLINGS, EACH UNR
Inciudes the Service andlor Power Supply up to 500 Amperes, All
Circuils and Two Inspection Trips Each Dweliing Unit @$8
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total fee is $20) ��' �
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I hereby cerlHy that I mspedad ttre electriml insfeliedan desa�ed herein an the dat� stffied:
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FOR OFFICE USE ONIY
REC'D MAY 17 2001
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��� Rough-fn Inapecdon Requtred? ❑ Yes �o Inspection Other Than Rough-In: ❑ Ready Ncw� WIU Cell
7"'s .P =`� You must cell the inspector when readyi Date Ready:
I certify that I am the �ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspec,fion of the electrical work at
Job Site Street Address City
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Tovmship Section Renge Fire No. CouMy
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�lOcxupent Name Please Provide Two (2) Phorte Num6ers Inctuding Area Code
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wrer Perfortning InsfaOadon) Please Provide Two (2) Ph
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