P - 76122REQUEST FOR ELECTRICAL INSPECTION
1� 7 8 7� O 8 3 � Minnesota Board of Electricity
1821 University Avenue Sufte 5-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
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_ G NERAL FEES Outdoor Liahtina Standard (�a $1
Transformers up to 10 KVA
Transformers over 10 KVA
200 Am re$10 Includes the Service andlor Power Supply up to 500 Amperes, All
N+kI+AUNICATION, REAAOIE CANTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit @$80
CIRCUITS OF LESS THAN 50 VOLTS Additional Ins cUon Tri $20
iystetn Device or Apparatus @$.50 Investigative Fee
ADDffIONS TO THE GENERAL FEES Reins 'on Fee @$20
ILY DWELLINGS PER UNI TOTAL FEE ^� e � O
� Units @$50 Per Unft (minimum total fee is $20)
1ddiNonal Unft @ $25 nnsnrsEaFwewsvecronuseauv
OTHER ADDITIONAL FEES
g RBITOfit @$25 pe� FixtUre I hereby certi(y that I inspected the el�trical installaGon dascribed herein on the dates slaffid:
5p@c+al Inspection Q$.31 per Mile
TH S WST�t1LI.ATION MAY BE ORDE
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DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS ___
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I � g/, ��`�� Rough-In Inspection Required7 ❑ Ye� �] No Inspection Other Than Rough-In: [�Ready Now ❑ WIII Call
You must call the inspector when readyl Date Ready:
I cQrt�y that I am the [� LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
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TownsFdp Section Range Fire No. County
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OwnedOccu nt Name Please Provide Two (2) Phone Numbers Including Area Code
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Contractor / Gompany Name
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M�ilir� Address 1Contractor Company or Oamer Performin
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(contrectoror
Contrsctor License Number Master Electrician or Pawer Limited Technician
C�j QQ$$,'y License Number
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Please Provide Two (2) Phone Numbers Including Area Code
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