P - 77489(?� (� REQUEST FOR ELECTRICAL INSPECTION
� ��V 7�:� 4 V 5 '� 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.state.mtt.us �
Describe -using the back of the whRe wpy if necessary - the work covered by this request:
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FEES
✓ICES I POWER
0 to 400 Amcere
� Above 200 Ampere @$10
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus $.50
ADDITIONS TO THE GENERAL F
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Additional Unit C� $25
Outdoor Lighting Standard (il $1
Transformers u to 10 KVA $10
Transformers over 10 KVA $ 20
Transformer I Power Supply for Si ns / Outline Liqhtin $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additionai Insoection Tri�s na $20
total fee is
OTHER ADDITIONAL FEES
9t $25 p@f FiXtufe I hereby cert' ihat I inspec,t�ed the electrical ir�sfallation desaibed herein on the dates staled:
ri ation Boom $40 �" �" o�.E
Home Park Lots $25 ,�; T-_ � f'.��--�� �
'ehicle Park Sites $5 FINLLINSP ,� !� / oATE
lin Ins ction $20 f c�` ,'��—CLj--L_ '� �3., 6?
eciallnspection $30perHour er�REO�nenNOa+Eo
ecial Inspection @ $.31 per Mile
INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12
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?0754057 '�)-7 ��L3-7
"°`;' Rough-in Inspection Required? ❑Yes �NO Inspection OtherThan Rough-In: Ready Now ❑Will Call
� You must call the inspector when ready! Date Ready: s
I certify that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Site SVee�ddr� � � �� � � I � � C� � 1 • � /�� �
actor / Company Nr,me f
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ig Address (CowVactor, Company or Owner Perfortning Im
rovitle Two (2) Phone bers Including Area
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�er Master Electrician or Power Limited T
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Please Provide T7 0(2) Phone I
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i Area Code