P - 77725REQUEST FOR ELECTRICAL INSPECTION
1��^2 6�.� � O � 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
0 NEW 0 RE L, AD�� RE' ^/P ��-u�g e�ack of the �e� � if= �e� nth� wak covered by this request:
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SERVICES I POWER SUPPLIES
0 to 400 Am ere , 525
401 to 800 Am ere $50
Above 800 Am re $75
CIRCUITS I FEEDERS
/ 0 to 200 Ampere � 55
Above 2(!0 Ampere @$10
ALARM, COMMUNICATION, REMOTE CONTROI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aooaratus � a.50
� Transformers up to 10 KVA @$10
i Transfortners over 10 KVA p$ 20
Transiortner I Power SupD�Y for Siqns I Oulline Liqh6nq .$5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes ihe Service �dlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dweliing Unit @ E60
Addition� Inspection Trips @ $20
Investigative Fee
Reinsoection Fee � $20
2 Units �$5o Per unit (minimum total fee is $20)
Addi60n21 Unit �$25 rN�s ue�, Foa ws�cTOrs usE aar
I haeby cerEty tlia� I inspecBed the ekcbical instaNation dexribed herein on the d�es staled:
OTHER ADDITIONAL FEES �7 ��,-y�� �/'Y�1 �
ng Retrofit (o� 3.25 per Fixture L.0 �V �-��10
, 600m � S4Q
Park Lots E
Park Sites ;
�peccbon @ S�
S30 cer Hour
I IIII II lll II lil ��I II �!! I I II)11 III II III a� I�i
172�61702
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rtequest uate: Rough-in Inspection Required? ❑ Yes 0 No Inspedion Other Than RaugMn: l�keady Now ❑ WNI Call
1� °�9'� You must wll the inspector wh� ready! Date Ready. , ��
I certify that I am the ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of Uie electrical work at:
Job Site Address (Street, .)� Ciry Zip Code
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INC.
Coon Rapids, MN 55433
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ise Nwnber AAaSter EJectrician or P
� License Number
Phone (s)
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EB-0OOOtA-74 8.1.2002