P - 761762 � � � � � � � REQUEST FOR ELECTRICAL INSPECTION �
s � ❑ Minnesota Board of Electricity %� �%),��
1821 University Avenue Suite S-128, Saint Paut,-Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.edectricity.state.mn.us
Describe -usir�hs` ck of the white copy'rf necessary - the work coverai by this requ�st:
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I SERVICES / POWER SUPPLIES
dbove 200 Am ere $10
ALARM, COMMUNICATION, REMOTE CANTROI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
3 to 12 Units @$50 Pe
Each AddRional Unit @
Fodure
Mile
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�� 0 7�t 2 6 0 3
Transfortners over 10 KVA $ 20
Transformer / Power Suppty for Sig� I Outline Ligh6ng @$5
ONE & N10 FAMILY DWEWNGS, EACH UNR
Includes tha Service andlor Power Supply up to 5� Rmperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
TOTALFEE C
total fee is $201 ��° �-✓�
I hereW ce�tltv tl�at I 6� tl�e etectrical h�Vffiton d� herefi on tlre ds0� �ted: �
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�� Rough-in Inspectlon Requiredl ❑Y� �do InspecUon OtherThan Rough-In: ❑ Ready Now �Cell
1� l?��p You must call the inspector when readyl Date Ready.
I certify that I am the L�ICENSED CONTRACTOR 0 COMPAIVY ❑ OWNER and hereby request inspe�ion of the electrical work at
Job Site Street Addr�s Cay
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Licen� Number
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