P - 76417��[ REQUEST FOR ELECTRICAL INSPECTION �
1� 9 7 7� g 3� �#. Minnesota Board of Electricity ���
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--- -_ 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 • s�
(651) 642-0800 TTY/MRS 1-800-627-3529 rvwiv.electricity.state.mn.us
Describe -using the back of the w' copy if necessary - t work covered by this request:
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GENERAL FEES Outd r Li htin Standard $1
SERVICES / POWER SUPPLIES Traffic Signal Standard $5
0 to 400 Ampere @$25 Supplemental Fee (a? $20
Above 800 Am ere $75
CIRCUITS I FEEDERS
0 to 200 Am ere $5
Above 200 Am re $10
ALARM, COMMUNICATION, REMOTE CANTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus $.50
ADDITIONS TO THE GENERAL F
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Additional Unit an S25
OTHER ADDITIONAL FEES
Fit @ $.25 per Fixture
rigation Boom @ $40
Home Park Lots an S25
Transformers over 10 KVA $ 20
Transformer I Power Suppiy for Signs / Outline Lightinq $5
ONE 8 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 Inspection Trips @ $20
� Investiqative Fee
TOTALFEE
total fee is $20) � Q
I hereby cer6fy that I inspected me elecfrical installation described herein on the dates stafed: �
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Special Ins ection $.31 per Mile
_THIS INSTALLATION MAY BE ORDERED DISCONNECTED lF NOT COMPLETED WITHIN 12 MONTHS
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19779354 � �
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Date: Rou h-in Ins ection R �
g p equired. ❑ Yes o Inspection Other Than Rough-In: ❑ Ready Now m144NC91f
3� — O I You must call the inspector when ready! Date Ready:
I certify that I am the CENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Site Street Address City
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Township Section Range Fire No. County
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Owner/Occupant Name Please Provide Two (2) Phone Numbers Including Area Code
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Eiectrical Utility Electrical UtilityAddress
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/ Co any Name �. .. . Contractor License�Number Mastar Electriciart or Power Limited Technician
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iress (Contractor, Company or Owne� Performing Installation) �j
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n re( ontractor or wner e rming Installation) Please Provide Two (2) Phone Numbers InGuding Area Code
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iNS ON BACK O ELLOW COPY BOARD OF ELECTRICITY COPY Fa_nnmm �_� s a� onnn