P - 81727�, REQUEST FOR ELECTRICAL INSPECTION
Minnesota 8oard of Electricity
�-37�J-728 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �,�
�� (651) 642-0800 TTY/MRS 1-800-627-3529
www. electricrty. state. mn. us �
Identify the work covered by this requesi: `,,. ,;, n � '�f." �
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�JEW ❑ REMODEL ❑ ADDITION ❑ REPAIR �
401 to
Above
:UITS /
IALARM, Ci
CIRCUITS.
TION, REMOTE CONTROL
OF LESS THAN 50 VOLTS
ice or Apparatus � $.50
f�ONS TO 7HE GENERAL I
INGS (PER UNI�
50 Per Unit
nit � $25
�THER ADDITIONAL FEES
! $.25 per Fixture
� $30 per Hour
� $.31 oer Mile
Transtormers over 10 KVA � $20
Transformers / Power Su I for Si s! Outline Li htln �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$80
Additional Inspecdon Trips � $20
Investi ative Fee
Reins ection Fee � $20
TOTAL FEE
� ' � � (minimum total fee is �20) 3Q`S�
Wfl INSPECTOR USE ONLY
I nereby certiry tnat I inspected me
RWGH IN
FNdOL INSPEC710N
on Me tlates stated: I
FOR OFFICE USE ONLY
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Request Date: Rough-in InspecTion Required? O Yes Inspection Other Than Rough-in: dy Now ❑ Will Call
3^ �� � You musl call the inspector when ready! Date Ready:
I certiiy that I am the CENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical wo�C at:
Job Address (Street, Box, or Route NoJ CHy Zip Code
a o� � ad � s-s-�. . �
Section Township Range Flre No. County
��
Occupant � � � � Phone
• L _ 4 lo �
Power Supplier Address
�ny Name Contracror License Number Master License Number
?��:c�- � C..W-v �.3b Q�
Company or Owner Performing Installation)
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BOARD OF ELECTRICITY COPY INSTRUCTIONS ON BACK OF YELLOW COPY