P - 76381REQUEST FOR ELECTRICAL INSPECTION �'�3
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^�.9 Minnesota Board of Electricity a��t �
��"� ��� v�� � 1 g21 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �
(651)642-0800TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
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Describe -usina the back of thewhite co�cif necessarv .the work coverEd.hv this ieauest:
I SERVICES I POWER SUPPLIES
CIRCUITS / FEEDERS (
0 to 200 Am ere a$5
Above 200 Am ere a$10
ALARM, COMMUNICATION, REMOTE CONTROL, SIG
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or Apparatus $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNf
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIO
Li htin Retrofit @$.25 per Fi�ure
Center Pivot Irriaation Boom a(� $4(
ing Standard
Standard a(�
Transformers over 10 KVA $ 20
Transfortner / Power Su I for Si ns I Outline Li htin $5
ONE & 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 Ins ection Tri s $20
Investigative Fee
Reins tion Fee $20
TOTAL FEE
(minimum total fee is $20) �
THIS AREA FOR INSPECTOR USE ONLY
I herebv certiN that I inspeded the eledrical installation described herein on ihe dates slated:
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Special Inspection $30 per Hour `^"^`","°"'"°""`° """ I
Special Inspection @ $.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
! RECD APR - 9 2001
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D t Rough-in Inspection Required? Yes ❑ No Inspectlon Other Than Rough-In: � Ready Now ❑ Will Cal�
You must call the inspector when ready! Date Ready:
I cert that m the I�LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Site Street Addre City
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or
or
Utility Address
�b�� ! � ''� � bD \ �
i�i ber Master Electrician or Power LimRed Techni�
License Number
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Please r'de wo 2 h e umbers Includin a Code
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FR-OOfH17A-75 A'I.