P - 76628(] REQUEST FOR ELECTRICAL INSPECTION '�
1 s 9 5:i aa 7 6 2 � 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
D -using the bac f the whit copy if nece�sa - the work covered by this request:
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GENERAL FEES Outdoor Li hting Standard $1
SERVICES I POWER S PPLIES Traffic Si nal Standard a$5
0 to 400
ALARM, COMMUNICATION, REMOTE CANTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or Ap aratus @$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units CaD $50 Per Unit
rigation Boom
Home Park Lc
INSTALLATION MAY BE ORDERED
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Supplemental Fee $20
Transformers u to 10 KVA a$10
Transformers over 10 KVA $ 20
Transformer I Power Su I for Si ns I Outline Li htin $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Inciudes the Service andlor 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 ection Fee a $20
TOTALFEE
(minimum total fee is $201 • �
I inspected ihe eledripl installation described herein on the dates stated: �
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IF NOT COMPLETED WITHIN 12
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ua�rl��/ Rough-in Inspection Required9 ❑Yes ��/� Inspection OtherThan
j ( ���b � � You must call the inspector when ready! Date Ready:
I certify that I am the �ENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby re�
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cpupant Na�
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Electrical Udlity
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�y or Owner
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q Owner Per1
ady Now ❑Will Call
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of the electrical work at
Niease rrohtle 1 wo (2) Phone N mbers Induding Area
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7�nse Nurt�r Master Electrician or Power Limited i
7i� J License Number
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Please Prov/id��e Two (2) Phone Numbers InGuding Area
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