P - 75459REQUEST FOR ELECTRICAL INSPECTION �` �''
1 s� 2�� 4, 7 0 � Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.stade.mn.us
Describe -using the back of the white cropy'rf necessary - the work covered by this reque.st:
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— GENERAL FEE Outd�r Lighting Standard @$1
SERVICES / POVdER SUPPLIES _ Tra(fic Sianal Standard al� $5
CIRCUITS / FEEDERS
0 to 200 Am $5
Above 2(10 Am ere a;$10
ALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
3 to 12 Units @$50 Per Unit
Each AddiUonal Unit an $25
i1Tlie
FEES
I�I II � II Ili li fi� � I{I II ell II III � III �� I�
18204701
Transfortners aver 10 KVA a$ 20
Transformer I Power Su I for Si ns / Outline Li Min $5
ONE & 1W0 FAMILY DWELLINGS, EACH UNIT
Includes tha Service and/or Power Suppty up to 500 Amperes, All
Circuits and Two Inspecfion Trips Each Dwelling Unft @$80
Additional Ins 'on Tri $20
Im ' ative Fee
Rein on Fee Q $20
TOTALFEE
(minimum total fee is $20) �. �
tws nrs�n wa rt+s�crort usE orar
I herebV cerbiY thffi I fnspetSed the etectrical insla0atlon d�d herein an dte da0es
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FOR pFFICE USE 4hLY
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��� Rough-fn Inspectlon ReqWr�7 ❑Yes ❑ No InspecHon Other Than Rough-In: ❑ Ready Now ❑WN Ca0
� o� �'� You must call the Inspector when readyl Date Ready.
I certify that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY '�OWNER and hereby request insp�ion of the elec6ical work at
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� Number MasOer Electridan or P
Ucer�se Number
Please Provide Two (2) Phorre Num��s I
(�63) S"7l• 3zoq ( )