P - 77051REQUEST FOR ELECTRICAL INSPECTION k��'�
�� 9 2 6- 9 2 8� Minnesota Board of Electricity �Q� .O�(p�7,G �,
1821 University Avenue Suite S-128, Samt Paul, Minnesota 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:
GENERA F ES Outdoor Lighting Standard $1
SERVICES / POWER SUPPLIES Traffic Si nal Standard $5
0 to 400 Ampere $25 Su plemental Fee $20
401 to 800 Am ere $50 Transformers u to 10 KVA $10
Above 800 Am ere $75 Transformers over 10 KVA $ 20
CIRCUITS / FEEDERS Transfortner I Power Su I for Si ns / Outline Li htin $5
0 to 200 Am re $5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re $10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CANTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit @$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ion Tri s $20
Each System Device or Apparatus $.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins ection Fee $20
MULTIFAMILY DWELLINGS PER UNIT TOTAL FEE
3 to 12 Units @$50 Per Unit (minimum total fee is $20)
Each Additionaf Unit (� $25 rws aaea Foa wsvecroa usE aar
Retfoflt @$25 per Fi�cture � � I hereby certiry that I inspected the electrical installaGon described herein on the dates stated: �
Manufactured Home Park Lots $25
Recreational Vehicle Park Sites $5 F�NA� �NSPecT�oN � onr�
Se arate Bondin Ins ection $20 % - a
SpECi21 In5p2CfI0f1 $30 pE� HOUf exviReornenrvoorvE� oarE
Special Ins ion $.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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Date: Rou h-in Ins ection Re uired?
g p q ❑ Yes o Inspection Other Than Rough-In: ❑ Ready Now ill Call
\ 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 �i�y
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+ccupani rvame Nlease Provitle Two (2) Phone Numbers �ncluding Area
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License Number
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