P - 81975REQUEST FOR ELECTRICAL INSPECTION
� Minnesota Board of Electricity
. �-$77-Q�7$ � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 _
(651) 642-0800 TTY/MRS 1-800•627-3529
www. e�ectricity. state.mn. us
Identity the work covered by this request:
O�FIEW ❑ REMODEL ❑ ADDITION 0 REPAIR
to 4(
)1 to
� ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
TIFAMILY DWELLINGS (PER
3 to 12 Units +� $50 Per Unit
Each Additional Unit � $25
lilill Illi1 �III 11lI1 III{! 11HI NIIM�fII IIII i�l
* 1 3 7 7 4 7 8 1*
l4CEL EtVERGY �AVER'S SWITGH
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformers ! Power Supply for Signs / Outline Lightinq �
ONE & TWO FAMILY DWELLINGS, EACH UNIT
tnciudes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two inspection Trips Each Dwelling Unit �$f
Additional Insoection Trins � $20
TOTAL FEE
total fee is $20)
FOP INSPECTOR USE ONLV
I hereby certify that I inspected Me electrical
• 1 '+ ROUGH IN
FOR OFFICE USE ONLY
�. -��� �-so
DATE
��
I Request Date: I Rough•in Inspecdon Required? ❑ Yes ❑ 14L I Inspection Other Than Rough-in: C7Ready Now LI Will Call �
Q�/�/�1 You must call the inspector when readyl Date Ready:
I certity that I am the f� LICENSED CONTRACTOR � COMPANY ❑ OWNER and hereby request inspection of the electrical work at: