P - 77034REQUEST FOR ELECTRICAL INSPECTION �
� � � � � � � 4 � ;� � Minnesota Board of Electricity �: � �
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
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�� a$ (651) 642-OS00 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
Describe -using the back of the white copy'rf necessary - the work covered by this request:
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GENERAL FEES Outdoor Lightin Standard $1
SERVICES I POWER SUPPLIES Traffic Si nal Standard $5
0 to 400 Am ere $25 Su lemental Fee $20
401 to 800 Am ere $50 Transformers u to 10 KVA $10
Above 800 Amcere Cd $75 Transformers over 10 KVA (�D $ 20
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or Apparatus $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Unfts @$50 Per Unit
Includes the Service andlor Power Suppty up to 500 Amperes, AI�
Circuits and Two inspection Trips Each Dwelling Unit @$80
Additional Ins ection Tri s $20
Irnesti ative Fee
Reins ction Fee $20
TOTALFEE
(minimum total fee is $20) Q��^
THIS AREP FOR INSPECTOR USE ONLY
I herebv certifv that I insoected the electrical installation described herein on the dates stated:
Manufactured Home Park Lots $25
Recreational Vehicle Park Sites $5 FINALINSPECTIQV onTe
Se arate Bondin Ins ion $20 — Z--- �s
SpeCi81 InSpeCtiOn $30 p2� HOU� E%PIREDIA94ND on�
Special Ins ion $.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED VWTHIN 12 MONTHS
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Date: Rou h-in In on R uired?
g spedi eq ❑ Yes �No Inspection Other Than Rough-In: � Ready Now Will Call
��� `, ` b� You must call the inspector when ready! Date Ready:
I certify that I am the�LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspecti�
Job Site SVeet Address City ` r �
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electrical work at:
Township Section Range Fire No. County
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OwnedOccupant Name � __ Please Provide Two (2) Phone Numbers InGuding Area Code
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Electrical Utility Electrical Utility Address
Contrador / Company ���� ^�tra� Ave � NE Co� dor License Number Master Electrician or Power Limited Technician
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Mailing Address (Contractor, QWqer j�qqpipg Installation)
or.0y�per Yeffortning Install on) Please Provide Two (2) Phone Numbers
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