P - 76379REQUEST FOR ELECTRICAL INSPECTION -�
1� 9 9�� 2 6� �� Minnesota Board of Electricity �
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
, (651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
Describe -ustng the back of the white copy if necessary - t work covered by this request:
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GENERAL FEES Outdoor Li hting Standard $1
SERVICES I POWER SUPPLIES Traffic Signal Standard @$5
Above 800 Am ere a$75
CIRCUITS I FEEDERS
0 to 200 Am ere c$5
Above 200 Am ere $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or Apparatus $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNII
3 to 12 Units @$50 Per Unit
Each Add'Rional Unfl @ $25
OTHER ADDITI01
Liahtina Retrofit (tD $.25 per Fixture
Manufactured
Recreational �
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
totai fee is
I hereby certiN ihat I inspected the elecUical installatian described herein on the dates slated: �
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Sial Ins ion @$30 r Hour `^""`", """""""" °°` I
Special Inspection @ $.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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Date: Rough-in Inspection Required? ❑ Yes o Inspection Other Than Rough-In: ❑ Ready No Will Call
�/ [� �� 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
Job Site SUeet Address C��Y
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Township Section Range Fire No. County A
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OwnedOccupant Name Please Provide Two ) hone Numbers Including Area Code
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License Number Master Electrician or
�O � � � License Number
or Owner Pertortning Installation)
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OPV BOARD OF ELECTRICITY COPV EB-OOOOtA-