P - 76494REQUEST FOR ELECTRI L I PECTION `�,
1 � 8 � % � � 3 2 � ' Minnesota Board of Electricity �0����� �- /q ;�,�„
❑ 1821 University Avenue Suite S-128, Saint Paul, Minn 55 4 °�
(651)642-0800TTY/MRS 1-800-627-3529 www.eleclricity.state.mn.us +"'':�
Describe -using the back of the white copy if necessary - the work covered by this request:
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GENERAL FEES Outdoor Liahtina Standard (� $1
401 to 800 Am ere $50
Above 800 Am ere $75
CIRCUITS / FEEDERS
0 to 200 Am re $5
Above 200 Am ere $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or paratus $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units @$50 Per Unit
Each Additional Unit (� $25
Su lemental Fee $20
Transformers u to 10 KVA $10
Transformers over 10 KVA $ 20
Transformer / Power Su I for Si ns / Outline Li htin $5
ONE & 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 Inspection Trips @ $20
Investigative Fee
Reinspection Fee C� $20
TOTALFEE
rot�i f� �S $zo� Byi� �'o
mi (a� �.zb 8f rlx[ufe I hereby ceAiry that I inspeded ihe eledncal installation descnbed herein on the dates stated:
Ircl ationB00m $40 Ro��"�" �*E
I Home Park Lots $25 � � . C►(`Jj
Vehicle Park Sites $5 FIW1L INSPECTION � `��
idin Ins ion $20 �'�---� �/— �
ecial InspecGon @$.31 per Mile I �
INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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1827132�
Rough-in Inspection Required? �les ❑ No Inspection Other Than Rough-In: ,�Ready Now�Vill Call
9/j(�/Q� You must call the inspector when ready! Date Ready:
I certify that I am the �ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Site Street Address City
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Section Range Fire No. County /
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Please Provide Two (2 Phone Numbers Including Area
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Elecfrical Utilitv Address
Contractor / Company Name
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Mailing Address (Contractor, Company or Owner Performing
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uthorized Signaturg(Contr�p[� wner Performing Inst
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OF YELLOW COPY BOARD OF ELECTRICITY COPY
Master Electrician or Powe
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o(2) Phone Numbers Including Are�
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