P - 77180REQUEST FOR ELECTRICAL IN�S�P,�CTI �� � �
� �.Q � �� � � � � �: � Minnesota Board of Electricity p�(JC�" �: �
��� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �
k-� ��-3 (651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
Describe -using the bac the 'te copy it ssary - the work covered by this request:
Ou)SU � �P� I ' '1-1 -� $�'S
GENERAL FEES Outdoor Lightin Standard $1
SERVICES I POWER SUPPLIES Trafic Sipnal Standard (�D $5
0 to 400 Ai
401 to 800
Above 800
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A aratus c$.50
ADDITIONS TO THE GENER4L FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Fee
�
over
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additional Inspection Trips @ $20
Investigative Fee
Reinspection Fee na $20
TOTALFEE
total fee is $20) ��}
I herebvi certifv that I inscected the electrical installafion described herein on the dates stated: I
ued Home Park Lots $25
nal Vehicle Park Sites $5 F�""�ir�cTi°" °"t��
Bondin Ins tion $20 - '�--"1,_.. � �' �'d-�
ispeCtiO� $30 pC� Hou� E%PIREU TA94NDONEO on�
�s n $.31 per Mile
ALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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I II�I II (II II (II I) II) (I I� II III (I (II II III
■� IN!
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Date: Rou h-in In ion R uired? ❑Yes o Ins
g specC eq pection Other Than Raugh-In: ❑ Ready Now Will Call
t V � l� �� You must call the inspector when ready! Date Ready:
I certify that I am the �iICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job� �treet Add �� � � , � � Cd� � �
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/CompanyP����!^'•••_ — •
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rovide Two (2) Phone Numbers Induding
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Master Electrician or Power Limited Technician I
License Number
�i�.Wrzetl Signature LCOnyBct�'��fyertortmrkj Inst�lladon) Please Provide Two (2) Phone Numbers I
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