P - 75844REQUEST FOR ELECTRICAL INSPECTION
1����� 3 7� � Minnesota Board of Electricity �
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104 ��
(651) 642-0800 T'fY/MRS 1-800-627-3529 www.edeciracity.state.mn.us
Describe -using �the'6ack�the whyite copy'rf the work covere�i by this request:
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RM, COMMUNICATION, REMOTE COMROI,
�UITS, CIRCURS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL F
TIFAMILY DWELLINGS (PER UNIn
3 to 12 Units CaD $50 Per Unit
Baom
�spection @ $.31 per Mile
'ALLATION MAY BE ORDERE[
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19813765
Supplemental Fee a $20
Transfortners u to 10 KVA a$10
TransFortners aver 10 KVA $ 20
Transformer / Power Su i for Si ns ! Outline Li hti $5
ONE & TN/O FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Suppty up to 500 Amperes, All
Circuits and Two Insp�tion Trips Each Dwelling Unit @$80
� Reinspectlon Fee � $20
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(minimum total fee is
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!CTED IF NOT COMPLETE
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described trerein on the dea�s stetetl: I
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Rough-in InspecGon R�ufred7 ❑ Yes �IVa Inspection Other Than Rough-In: 0 Ready Now�Wlll Cell
��/ �� �(o You must call the inspector when readyl Date Ready:
I cerMy that I am the�'LICENSED CONTRACTOR ❑ COMPANY p OWNER and hereby request ins�ction of the electricel wrork at
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Contractor License Number Master D�Idan or Prnrer Lirr
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Please Provide T o(2) Phorte Numbers IrrcJuding
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