P - 77519Q REQUEST FOR ELECTRICAL INSPECTION
1�� O�- 9 3 9 6 Minnesota Board of Electricity `r�: `..�
❑ 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 - _
(651) 642-0800 TTY/MRS 1-800-627-3529 wx�n�.electricity.slale.mn.us
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G�NERAL FEES Outdoor Liahtina Standard (a� �t
I POWER SUPPLIES
we 200 Ampere @$10
COMMUNICATION, REMOTE CONTR01
S, CIRCUITS OF LESS THAN 50 VOLTS
ADDITIONS TO THE GENERAL FEES
Y DWELLINGS (PER UNIT)
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER AD
�ark Lots @ $25
�ark Sites @ $5
pection @ $zo
$30 per Hour
Traffic Signal Standard
Suoolemental Fee an $
Transformers u to 10 KVA $10
Transformers over 10 KVA $ 20
Transformer I Power Su I for Si ns / Outline Li htin $5
ONE 8 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 ection Tri s $20
Investigative Fee
Reinspection Fee @ $20
TOTALFEE �'+;j,,;:�!;�
(minimum total fee is $20)
iH15 AREA FOR INSPECTOr2 USE ONLY
I hereby certify that I inspected the electrical installation descnbed herein on the dates stated:
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AtSTALLATION_MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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��� ug�e. ��. Rou h-in Ins ection Re uired? � p g j�Ready Now � Will Call
. g p q ❑ Yes .�[] No � Ins ection Other Than Rou h-In:
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�� You must call the inspector when ready! � Date Readv:
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I certi#y that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER
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I Job SiFe Street Address
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and hereby request inspection of the electrical work at:
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�----OwnedOccu ani Name . — i - — I __ _. �
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��,,, : P � fi e! i L� ' Please Provide Two
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dumbers Including Area
, EI lectnCal Utility , Electrica Utili(y Address � � � —�
�. �� r � r° ��P^ Y_� �� - . ^ _ _ _ --- -��Contractor License Number - Master Electrician or Power Limited Technician '!,
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Contra�ctor / Com an Name
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�, MaUuig Address (Contractor. Company or Owner Performing Installation) � --- "�-
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Authorizgd S� nature Contractor or Owner Performin Instatlation , Please Prowde Two (2) Phone Numbers Including Area Code
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INSTRUC7lONS ON BACK OF YELLOW COPY BOAR� OF ELECTRICI7Y COPY � �� ra nnnme_�c o, o���