P - 77652REQUEST FOR ELECTRIC L INSPECTIO ��'�3'
� 1�� 8���'� 6 g g� Minnesota Board of Electricity �Q�S—/'��� r �� � ':p
1821 University Avenue Suite S-128, aint Paul, Minn`eso�a 5��4 �`
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
Des�ibe -using the back of the white copy if pecessary - the work covered by this request: �
��'�a� s�.e''v<�,t' C�'C��.S�� _ C�.z.,c� � � r�'t �✓/��'J'I � �
GENERAL FEES Outdoor Lighting Standard $1
SERVICES / POWER SUPPLIES Traffic Signal Standard $5
0 to 400 Ampere $25 Su plemental Fee $20
401 to 800 Am re $50 Transformers u to 10 KVA $10
Above 800 Am re $7 Transformers over 10 KVA $ 20
CIRCUITS I FEEDERS Transformer I Power Su I for Si ns / Outline Li htin $5
0 to 200 Am re $5 ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere $10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, MOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit @$80
CIRCUITS, CIRCUITS OF L S THAN 50 VOLTS . Additional Inscection Trios (� $20
Each System Device or
ADDITIONS TO THE GENERAL F
MULTIFAMILY DWELLINGS PER UNiT
3 to 12 Units @$50 Per Unit
Each Addifional Unit C� S25
f Home Park
Vehicle Park
edal Inspection @$.31 per Mile �
INSTALLATION MAY BE ORDERED i
III�I IIIII IIIII IIIII IIIII I�III IIIII IIIII �� I�
18476895
TOTAL FEE
total fee is $20) ,� j�,
I inspected the elechical installa6on described herein on ihe dates stated:
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IF NOT COMPLETED WITHIN 12 MONTHS
� Rough-in Inspection Required? ❑Ye No Inspection Other Than Rough-In: ea w❑ Will Call
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� l.� � You must call the inspector when ready! Date Ready: �C G�
I certify that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Ske Street Addre _ ��y
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Township Section Range Fire No. CounN /\ ,
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rical Utility Address
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wide Two (2) Phone Numbers Including Area
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.K //�� �nx �vurnoer mas�er ciecmaan or
���-, _/ ( . ,�� ���� License Number �
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�any or wner Perfo g Ins allatio ) /� ,•�
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or Owner Performing Installatlon) Please Provide Two (2) Phone Number
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I COPY BOARD OF ELECTRICITY COPV
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