P - 773691 REQUEST FOR ELECTRIC L INSPECTION ���
1��� 1- 3 3 7 9� Minnesota Board of Electricity p�QQS -0/pj� r;-
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
' (651) 642-0800 TTY/MRS 1-800-627-3529 x�ww�.electricitv.state.mn.us
Describe -using the back of the white copy it neGegg�,the ar�tkFo,u�Fgd,by�is `�Qu�t; S�� � i LH
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GENERALFEES
SERVICES I POWER SUPPLIES
0 to 200 Am re $5
Above 200 Ampere @$10
ALARM, COMMUNICATION, REMOTE CONTROL, SIG
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL FEES
AAULTIFAAqILY DWELLINGS PER UNIT
3 ro 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
LigMing Retrofit C� $.25 oer Fixture
LOtS $2�
Sites (� $5
Hour
Outdoor Lighting Standard
Traffic Siqnal Standard (c�
Transformers over 10 KVA $ 20
Transformer I Power Su I for Si ns I Outline Li htin $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
NG Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additional Ins ection Tri s $20
Investigative Fee
Reinspection Fee $20
TOTAL FEE
(minimum total fee is $20) Z�•�� ��
THIS AREA FOR INSPECTOR USE ONLY
I hereby certify that I inspected the electrical installation described herein on the dates stated:
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>TALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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17813379
�"{!`� i`'4� U� Rough-in Inspection Required? ❑ Yes �] No � Inspection Other Than Rough-In: [�Ready Now ❑ Will Call
I_ T , You must call the inspector when ready! _�_Date Ready:
I certify that I am the 'L1 LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
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Ele ical Utili[ � Eledrical Utility Address I� �
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(Contractor or Owner Performing Installation) ? ��p2� �
INSTRUCTIONS ON BACK OF YELLOW COPY eOARD OF ELECTRICI7V CoPV
Jumbers Including Area
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Master Electrician or
License Number
Numbers Including Area
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