P - 77057REQUEST FOR ELECTRIC/�L IN ECTION ��'�
1� J�� - 9 3 2� Minnesota Board of Electricity �(��(���� �- �- �
,� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �-
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.u.r ��
Describe -using the back of the white copy if necessary • the work covered by this request:
, � 1 -
0 to 400 Ampere $25
401 to 800 Am ere $50
Above 800 Am re $75
CIRCUITS I FEEDERS
0 to 200 Am ere $5
Above 200 Am re $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIO
Liqhtinp Retrofit (cD $.25 per Fixture
Traffic Signal Standard
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
Additional Inspection Trips @ $20
Investiqative Fee
TOTAL FEE
total fee is $20)
I inscected the electncal installafion described herein on the dates stated:
w W�
te Bondin Ins ion $20 � � �
I �fISP2Ct10f1 @$3� �f HOUf ExPiaEOrnenNOaoEO on�
I Inspection $.31 per Mile
>TALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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Date: Rough-in Inspection Required? ❑ Yes � No Inspedion Other Than Rough-In: ❑ Ready Now�Will Call
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You must call the inspector when ready! Date Ready:
I certify that I am the ICENSED CONTRACTOR ❑ COMPANY � OWNER and hereby request inspection of the electrical work at:
Job Site Street Address Ci�y� _ �`
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:i�:e Electric Serv
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ise Number Master Eledrician or Power Limited Techni�
�� License Number
Please P�ide Two (2) Phone Nurr�ers Including Area Code