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1 810 611 � REQUEST FOR ELECTRICAL INSPECTION 7.�;,:�
� � Minnesota Board of Electricity K� �
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �
(651)642-0800TTY/MRS1-800-627-3529 www.electricity.state.mn.us ���
Describe -using the back of the white copy if necessary: they�vork covered by this request: �
SERVICES / POWER SUPPLIES
0 to 400 Ampere @ $25
401 to 800 Am ere $50
Above 800 Am re $75
CIRCUITS / FEEDERS
0 to 200 Am re $5
Above 200 Am re $10
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or Apparatus $.50
ADDITIONS TO THE GENERAL Fi
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Unfts @$50 Per Unit
Each Additional Unit itl S25
rigation Boom
Home Park La
Traffic Si nal Standard @ $5
Supplemental Fee $20
Transformers u to 10 KVA $10
Transformers over 10 KVA a$ 20
Transformer / Power Su I for Si ns / Outline Li htin $5
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
Additional Inspection Trips @ $20
investiqative Fee
TOTAL FEE
total fee is $20) �D . c�
I inspeded the electrical inslallatian described herein on the dates staled: �
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5peciallnspection $30perHour ExP��n�"ar�+oor�o �.-----
Special Inspection $.31 er Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 1
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Rough-in Inspection Required? �es ❑ No Inspection Other Than Rough-In: ❑ Ready Now ❑ Will Call
S� l J— �� You must cail the inspector when ready! Date Ready:
I certify that I am th LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Site Street Address City
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Township �� Section Range Fire No. County
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Please I
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Electrical Utility Address
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or
or Owner
(2) Pfione Numbers Including Area Code
(�l� �ac— YY�
License Number I Master Electrician or Power
License Number
Please Provide Two (2) Phone Numbers I
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