P - 77044� REQUEST FOR ELECTRI L INSPECTION �'��
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�Q�Q Minnesota Board of Electricity �� ��% � �� ;�
� V V�- 8 9 9 0 1821 University Avenue Suite S-128, Saint PauT Minnesdta�5104 �� �,.
(651)642-0800TTY/MRS t-800-627-3529 wwx�.electriciry.state.mn.us �`'' "��
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Describe -using the back of the white copy if necessary - the work covered by this request:
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GENERALFEES i ,
401 to 800 Am ere $50
Above 800 Am ere $75
CIRCUITS / FEEDERS
0 ta 200 Am re $5
Above 200 Am ere $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 ADDITIONAL FEES
Liqhtina Retroft aC� $.25 oer Fi�ure
utdoor Lighting Standard @ $1
Traffic Signal Standard @ $5
Supplemental Fee $20
Transformers u to 10 KVA $10
Transformers over 10 KVA $ 20
Transformer / Power Su I for Si ns / Outline Li htin $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 la� $20
TOTALFEE ,/
total fee is $20) ,'Y(1 •�
I inspeded ihe elecUical installation described herein on the dates staled: �
K0Cf08tI0f181 V0111CIB F'8fK JItBS �$b �"'""'•'�`"""" , """ /
Se arate Bondin Ins ection $20 � i• C� j
S�Ci81 InSpCCilOfl $30 p8f HOUf exaiaeo�nenNOONeo onre
Special Ins ction $.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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1,8858993
Date: Rough-in Inspedion Required? ❑ Yes �rvo Inspection Other Than Rough-In: ❑ Ready Now�ill Call
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1C;' l_i _3 i��--7 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 Cit��
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Name
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763
( OF YELL
Section Range
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Fire No.
Please Provide
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i Please
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I(:ITV C:nPV
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r Master Electrician or Power Limited Technician
License Number