P - 77599REQUEST FOR ELECTRICAL INSPECTION ��
1� 1��- 511 7� Minnesota Board of Electricity �r-
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
' (651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
D s n - he back of the fi ecessary - the work covered by this request:
I SERVICES / POWER SUPPLIES
Above 800 Am ere $75
CIRCUITS I FEEDERS
- 0 to 200 Am ere $5
Above 200 Am ere $10 -
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Manufactured Home Park Lots
Recreational Vehicle Park Site,
Outdoor Lighting Stand
Traffic Signal Standard
Supplemental Fee @ $
Transformers uo to 10
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
Investiqative Fee
(minimum total fee is $20) � $85.50
iHIS AREA FOR INSPECTOR USE ONLV
I hereby certify that I inspected the elechical installation described herein on the dates stated:
ROUGHIN / DATE
\ •. ✓� �i�".... �. IJ��v%�7Y'�'I
Special Inspection @$30 per Hour GY1Ht0 AtlAN°ONt° — °"" I
Special Inspection @ $.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
I' II �7-�-�- y
�IIII ��III III�) II�N ��III �I�� �IIII IIIN III� II��
1 7 7 5 5 1 1 7 ��5��0020 �
Robert Clauson INSPECTED LOCALLY �
Dat . � Rough-in Inspection Required? �es ❑ No �'i Inspection Other Than Rough-In: ❑ Ready Now�Will Call
__ 2�� ��ZD�rJ _ ' You must call the inspector when ready! �Date Ready:
I certify that I am theJRI ILICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Site Street AddresS�' �� � � , C�—
'. OwnedOccupant Name
�' Electrical Utility ''�, Electrical Utility Address
Y�� �(�DC1 _�_ 3115 Centre �ointe DrivE, Rosevil
' Con6�C`fd(��i�arl+�—" ' , Contractor License Number
or
Provide
021 � � �
IN 55113 - (8001628-2121
Master Electrician or ower Limited Technician ,
License Number
�o (2) Phone Numbers Including Area Code
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