P - 77595REQUEST FOR ELECTRICA INSP� CTIO `T�`Fy�
1�-9'� �- 2 9 5 0 Minnesota Board of Electricity ��Qj r�/ � k�� �
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1821 University Avenue Suite,S-128, Saint Paul, Minnesota 55104 i�.
(651) 642-0800 TTYIMR� �0-627-3529 www.electricity.state.mn.us ��
Describe - sing the back of e hite copy if necessary - the work co ered by this request
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ENERAL FEES Out r Lighting Standard @$1
SERVICES / POWER SUPPLIES Traffic Signal Standard @$5
0 to 400 Ampere @$25 Supplemental Fee $20
401 to 800 Am ere $50 Transformers u to t0 KVA $10
Above 800 Am ere $75 � Transformers over 10 KVA $ 20
CUITS / FEEDERS Transformer I Power Su I for Si ns I Outline Li htin $5
0 to 200 Am ere $5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere $10 Includes the Service and/or Power Suppiy up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit @$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ection Tri s $20
Each System Device or Apparatus $.50 Investigative Fee
ADDITIONS TO THE GENERAL FEES Reins ection Fee $20
MULTIFAMILY DWELLINGS PER UNIT TOTAL FEE •�
3 to t2 Units @$50 Per Unit (minimum total fee is $20)
Eaeh Additional Unit @$25 Tr+is naen FoR iNSaeeTOe use oNiv
OTHER ADDITIONAL FEES
Liqhtinq Retrofit an. $.25 pCf Fiz�ufe I hereby certify ihat I inspected the elecVical installation descnbed herein on the dates stated:
Recreational Vehicle
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Special Inspection @$30 per Hour `""""°,""""""`'' °"" I
Special Inspection @ $.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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18812958
Date: Rough-in Inspection Required? ❑Yes /�he-� Inspection OtherT���gh�:� Now ❑Will Call
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You must call the inspector when ready! Date Ready: V
I certi(y that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job S e SVeet Ad V J �� �� ��-�--•
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Town hip Sedion Range Fire No. County
Ow�'Occuoant Name . ._ Please Provide Two (2) Phone Numbers Including Area Code
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Company Name //��ff . Contr333ccc���or�L�cense Number Master Electrician or Power Limited Technician
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�r Per�orming t taMtionr — I Plea� �e P[nyi�Two (2) Phone Numbers I
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BOARD OF ELECTRICITV CO Y