P - 76462REQUEST FOR ELECTRICAL INSPECTION
1� 1 V�- 9 0 4 O Minnesota Board of Electricity ��� `_
❑ 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �
(651)642-0800TTYlMRS1-800-627-3529 wwtir.electriciry.state.mn.us
Describe -using the back of the white copy it ne�e,� `a�: �the �o�I�Fquer.�d.by,t�iis� 4e�e�ue�t; ..; �, ,..�..;,�
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GENERALFEES
0 to 400
Af.qRM, COMMl7NICATION, REMOTE CONTROL, SIGI
CtRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
1T ADDITIONS TO THE GENERAL FEES
tp 12 Units @ $50 Pe
ach AddiUonal Unit @
ReVofii (�a $.25 per Fixture
Outdoor Lighting Standard @ $1
Traffic Signal Standard @ $5
Supplemental Fee @ $20
Transformers u to 10 KVA $10
Transformers over 10 KVA $ 20
Transiormer I Power Su I for Si ns I 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 Trips $20
Irnestigative Fee
Reinspection Fee $20
TOTAL FEE '_,•:[;+,
(minimum total fee is $20)
that I insoected the eledrical installation descnbed herein on the dates stated:
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?cial Ins tion @$30 per Hour `""'"`° "°"'"°""" U""
;cial Inspection @ $.31 per Mile
IAI$TALLATION AAAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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' Date: I, Rough-in Inspection Required? ❑ Yes ��] No i Inspection Other Than Rough-In: [�Ready Now ❑Will Call
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j i 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:
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I Job Site Sheet Address �ty fi j;• j j i� i::. •i: � �,! c�:.jt'! .:� �.
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� OwnedOccupant Name
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Fire No. I County
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� Please Provide Two (2) Phone Numbers Including Area Code
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; ElecfriCal UtilitY I Electrical Utility Address
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onhador / Company Name � � -�Contractor License Number i Master Electrician or Power Limited Techni�
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' tdaiN�g Address (Contractor, Company or Owner Performing Installation)
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I A�ix9d $i n��ntrector or Owner Performing Installation) Please Provide Two (2) Phone Numbers Induding Area Code
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