P - 77497REQUEST FOR ELECTRICAL INSPECTION q�'�
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2 067 431 � ��� �W °�
� � Minnesota Board of Electricity K� ,�,
1821 University Avenue Suite Srt2 ' aint Paul, Minnesota 55104
_ (651) 642-0800 TTY/MRS 1- - 529 www.electricity.state.mn.us
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Describe - th ba k f the de copy i ssary - the wQrk covered by his est.
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401 to 800 Am ere a$50
Above 800 Am ere $75
CIRCUITS / FEEDERS
0 to 200 Am re $5
Above 200 Am re $10
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or Apparatus $.50
ADDITIONS TO THE GENERAL F
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Uniis C� $50 Per Unit
unit @ $25
OTHER ADDITIONAL FEES
(c� $.25 per Fixture
PiVOt
Outdoor Li htin Standard $1
Traffic S' nal Standard $5
Su lemental Fee $20
Transformers u to 10 KVA $10
Transformers over 10 KVA $ 20
Transformer I Power Su I for Si ns / Outline Li htin $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additional Inspection Trips @ $20
Investiaative Fee
TOTAL FE j I �l' D. ��
total fee is $20
I hereby certiy that I inspected tl�e electrical installation described herein on the dates slaled: �
arate Bondin Ins ion $20 � �`—•'�
eciallnspection $30perHour EXPIREDIAfl4NDONED p�fr
ecial Inspection $.31 per Mile
INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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IIIII IlIII II��I IIIII I�II� Il�ll IIIII IIIII �III I� .,., .
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Rough-in Inspection Required? ❑ Yes No ection Other Than Rc
You must call the inspedor when ready! � Date Ready:
I certify that I am th�LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby re e
Job S'�ddress� �" / / / � � C�Y
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ipany Name
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Fire No.
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of the electrical work at:
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u License Number Master Electncian or Power Limited 1
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Please Provide Two (2) Phone Numbers Including Area
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