P - 77692REQUEST FOR ELECTRICAL INSPECTION F
1��8 �� 0 5 4, 6� Minnesota Board ot Electricity p�� j�a�v� 7"f� �-: �
��� 1821 University Avenue Suite S-128, Sain" t Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-500-627-3529 www.electricity.state.mn.us
D 'be -using the back of the white copy'rf necessary - the work covered by this request:
GENERAL FEES utdoor Li hting Standard $1
SERVICES I POWER SUPPLIES �, Traffic Siqnai Standard fiD $5
Above 800 Am ere $75
CIRCUITS I FEEDERS
0 to 200 Am ere a$5
Above 200 Am re $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIG
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A aratus $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units @$50 Per Unit
Each Additional Unit an $25
Transformers over 10 KVA $ 20
Transfortner / Power Su I for Si ns I 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 Ins tion Tri s $20
Investi ative Fee
Reins ction Fee $20
TOTAL PEE C.�
(minimum total fee is $20) v°�
V
THISAREAFORINSPECTORU NLY
I heieby cer6ry that I inspected fhe electrical installa6on described herein on ihe dales stated:
factured Home Park Lots $25
ational Vehicle Park Sites @$5 F"�"�'"s�c
ate Bondin Ins ection $20
allnspection $30 rHour E%PIREDIFE
al Inspection $.31 per Mile
STALLATION MAY BE ORDERED DISCONNECTED
I l�l ll lll ll l�i ll lil ll lll ll lll il lll ll lll �l� l�
L8565465
C�- C-�-` 5 � �
WITHIN 12 MONTHS
� }::���� - �*.'�_.
��=�' Rou h-in Ins
v1 '('�, /�� 9 Peotion Required? ❑ Yes ❑ No Inspection Other Than Rough-In: ❑ Ready Now ill Call
5 You must rall the inspector when ready! Date Ready:
I certify that I am the L�ICENSED CONTRACTOR ❑ COMPANY � OWNER and hereby request inspection of the electrical work at:
Jo�; e Sheet Address ` � /� � \ ^ � a ` ,
Township Se
er/Occu Name
�� �
ElecVical Utility Ele
Co or / pany Name �
Mailin ress (ConV or, Company or Own Perfon
� � .
AlR►+Qrized Signature (Contractor or Own�F�forming
\ \ f\ L
Provide Two (:
���`�
(2) F
�