P - 77046REQUEST FOR ELECTRIC L II�LSP/�E-C�TION �
Q Minnesota Board of Electricit � �� ��
1�� V�- 8 9 4 � 1821 University Avenue Suite S-128, Saint Paui, Min�ota 55104 � �.
(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:
0 to 400 Ampere (
401 to 800 Am r
Above 800 Ampei
CIRCUITS / FEEDERS
0 to 200 Amcere (
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Liqhtinq Retrofit f�D $.25 cer Fixture
Hour
Mile
4Y BE
Traffic Signal Standard
Supplemental Fee @ $
Transformers up to 10
Transformers over 101
Includes the Service and/or 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 ection Fee $20
TOTALFEE —�
(minimum total fee is $20) � � � V
THIS AREA FpR INSPECTOR USE ONLY
I herebv certi(v ihat I insoeded the electrical installation described herein on the dates stated:
DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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1 8 8 5 8 9 4 4
Date: Rough-in Inspection Required? ❑ Yes �o Inspection Other Than Rough-In: ❑ Ready Now �Vill Call
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�� �( t�-�' ��-� You must call the inspector wl�en ready! Date Ready:
I certi(y that I am the�LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at