P - 77054REQUEST FOR ELECTRICP�I� INS E�� ���
1�� � V- 9 3 0� Minnesota Board of Electricity J-�Q� � �- �
� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 5510� �' '
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
Describe -using the back of the white copy if necessary - the work covered by this request:
GE FEES Outdoor Li hting Standard $1
SERVICES / POWER SUPPLIES Traffic Siqnal Standard (a? $5
0 to 400 Am ere $25
401 to 800 Am re $50
Above 800 Am ere $75
CIRCUITS I FEEDERS
0 to 200 Am re $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 AddiGonal Unit @ $25
OTHER ADDITIONAL
Liqhtina Retroffi an $25 per Fi�Rure
S ial Inspection @$30 r Hour
Special Inspection @ $.31 per Mile
THIS INSTALLATION MAY BE ORDERE
i I I I I II I II I I I I I I I I I I I I I II II I II I I II I II III fl I� I��
L9269307
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 ction Tri s $20
Investi ative Fee
Reins ction Fee $20
TOTALFEE -�}�
(minimum total fee is $20) p� -�v
THIS AREA FIXi INSPECTOR USE ONLV
I hereby certify that I inspeded the eleclrical installa6an described herein an the dales stated:
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IF NOT COMPLETED WITHIN 12 MONTHS
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Date: Rou h-in Ins ion R uired?
g pecC eq ❑ Yes No Inspection Other Than Raugh-In: ❑ Ready Now ill Call
`� ��,�� You must call the inspector when ready! Date Ready:
I certify that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Site Street Address Cit�--'
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UUlity
°i�1Q1e E lectric Services �ntrador License Number Master Electrician or Power Limited Technician
License Number
� r, y P in s tion)
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