P - 76402REQUEST FOR ELECTRICAL INSPECTION '� ��'�
1 �2� 260 a , �� �
� a� Minnesota Board of Electricity � k �
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �
`_ (651)642-0800TTY/MRS 1-800-627-3529 www.electricity.state.mn.us ��
:seribe -using the back of the white copy if necessary - the work covered by this request:
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GENERAL FEES Outdoor Lighting Standard @$1
=RVICES / POWER SUPPLIES Traffic Siqnal Standard Ca) $5
0 to 400 Ar
401 to 800
Above 800
CIRCUITS / FEE
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNAIING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or Apparatus @$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units CaD $50 Per Unit
Center Pivot Irrigation Boom @
Manufactured Home Park LoGs
Recreational Vehicle Park Sfle:
S ecial Inspection a$.31 per Mile
THIS INSTALLATION MAY BE
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18202606
Transformers over 10 KVA $ 20
Transformer I Power Supply for Signs / Outline Lighting $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 Insoection Trios lc� $20
TOTALPEE / U
(minimum total fee is $20) �//,
THISAREA:ORINSPECTIXtU LY
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�eby ceAiy fhat I inspeded the electrical insfalla6on desaibed herein on the dates stated:
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INSPECTION ONTE
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IF NOT COMPLETED WITHIN 12 MONTHS
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Date: Rou h-in Ins ection R
g p equired? ❑ Yes ❑ No Inspection Other Than Rough-In: � Ready Now � Will Call
p� Q/ You must call the inspector when ready! Date Ready:
I certify that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY L�1'�NER and hereby request inspection of the electrical work at:
Job SRe Street Address City
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Township Section Range Fire No. County
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Owner/Occup nt Name Please Provide Two (2) Phone Numbers Including Area Code
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/CompanyName
Mailing Address (Contrador, Company or Owner Performing In:
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Authorized Signature (Contractor or Owner Perfortning Instpll.
License Number I Master Elec[rician or
License Number
se Provide Two (2) Phone Numbers Including Area Cc
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