P - 76467REQUEST FOR ELECTRICAL INSPECTION °'��'�
1�� V�- 9 4 0❑4 Minnesota Board of Electricity �
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �,
i (651) 642-0800 TTY/MRS 1-500-627-3529 wxx.electricrtti�.stale.mn.us
Describe -using the ba,k, ��f the white copy if ne,ces�_ ,.the� �q.v,ere�,bythi,� je,qugst : ... .. .:....:..:
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GENERALFEES
Outdoor Liqhtina Standard
0 to 400 Ampere �25 Supplemental Fee @$20
401 to 800 Am re $50 Transformers u to 10 KVA $10
Above 8D0 Ampere $75 Transformers over 10 KVA $ 20
:UtTS I FEEDERS Transformer I Power Su I tor Si ns I Outline Li htin $5
0 to 200 Ampere @$5 ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$10 Includes the Service andlor Power Supply up to 500 Amperes, All
iM. COMMUNICATION. REMOTE CONTROL. SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit @$80
CIRCUITS OF LESS THAN 50 VOLTS
>yst�m Device or Apparatus @ $.50
ADDITIONS TO THE GENERA� FEES
'LY DWELLINGS (PER UNIT)
iBoom @
Park Lots i
Park Sites
Fee
TOTALFEE
total fee is $20)
lhat I insoecled the electrical installation described herein on the dates stated:
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S cial Inspection @$.31 per Mile
S iNSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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; Date: Rou h-in Ins ection Re uired? ❑ Yes �I
'.,. 8' .f i![' *F� I g p q �]] No I Inspection Other Than Rough-In: [�Ready Now ❑ Will Call
� You must call the inspector when ready! ', Date Ready:
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I cettify that I am the L] LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
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Range
rOwne[/Qccupant 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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I EleCtrjcFa�l Utility ' Electrical Utility Address
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':�Cpntractor / Company Name � —� �� Contractor License Number I Master Electrician or P�
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I, Mailing Address (Coniractor, Company or Owner Performing Installation)
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AutlZwized 3' nature (Contractor or Owner Performing Installation) �� Please Provide Two (2) Phone Numbers I
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