P - 76510(� REQUEST FOR ELECTRICAL INSPECTION
1� J 6���� 2 � Minnesota Board of Electricity �;
1821 University Avenue Suite S-128 a�( P I, innesota 55104
(651)642-0800TTY/MRS1-800-6 7� .electricity.state.mn.us
Describe -using th ck of the white copy'rf ecessary - the co er by this request: n
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GENER4L FE Outdoor Li tin Standard $1
SERVICES I POWER SUPPLIES Traffic Signal Standard $5
0 to 400 Am ere $25 Su lemental Fee $20
401 to 800 Am ere $50 Transformers u to 10 KVA $10
Above 800 Am re $75 Transformers over 10 KVA $ 20
CIRCUITS I FEEDERS Transformer I Power Su I for Si ns I Outline Li htin $5
0 to 200 Am re $5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re $10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit @$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ion Tri s $20
Each System Device or Ap aratus $.50 Irnesti ative Fee
ADDITIONS TO THE GENERAL FEES Reins ection Fee $20
MULTIFAMILY DWELLINGS PER UNIT TOTAL FEE
3 to t2 units @$50 Per Unit (minimum total fee is $20) �� ' S�,
EeCh Additlonal Unit (rD $25 THISAREAFORINSPECTORUSEONLY
I hereby certify that I inspeded ihe electrical insfallation described herein on Ne dates stated: �
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Special Ins on $.31 r Mile
_ THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 N
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� j� �� Rough-in Inspection Required? ❑ Yes ❑ No Inspedion Other Than Rou h-In. �] Read Now
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You must call the inspector when ready! Date Ready:
I certify that I am the LICENS CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work ai
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rtor / Company Name Contrador License Number Master Electrician or Power Limited T
�7EPENDABLE ELECTRIC, INC. � �; _=` �`_ "ce"�"°'"��jyr � �_
or chnner Pertorjn�g Installation) � Please Provide Two (2) Phone Numbers InGudinA Area Code