P - 77425REQUEST FOR ELECTRICAL IN PE�TION ���'�'�
10 $� 2� 5 8 7 � Minnesota Board of Electricity O� QQ� ` y k, �
1821 University Avenue Suite S-128, Saint Paul, Minneso�65��4 �"�
(651) 642-0800 TTY/MRS 1-500-627-3529 www.electriciry.state.mn.us ��
Describe -using the back of the white wpy iCf necessary - the work covered by this request: ('�
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GENERAL FEES Outdoor Lighting Standard @$1
SERVICES I POWER SUPPIIES Traffic Si nal Standard $5
0 to 400 Ampere $25 Supplemental ee $20
401 to 800 Am re $50 Transfortners u to 10 KVA $10
Above 80�Ampere $75 Transformers over 10 KVA (� $ 20
CIRCUITS I FEEDERS
0 to 200 Am re $5
Above 200 Ampere $10
ALARM, COMMUNICATION, REMOTE CANTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or Apparatus $.50
ADDITIONS TO THE GENERAL F
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Addi6onal Unit (o� $25
Home Park Lots �
'ehicle Park Sites
THIS INSTALLATION MAY BE ORDERED 1
I(III II I� �I II) (I III II III II III II III II II) �� (UII
�,81,�5872
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additional Inspection Trips @ $20
Investigative Fee
Reinspection Fee an $20
total fee is
I hereby ceAity that I inspeded the eledrical installation described herein on the dales stated: �
IF NOT
12 MONTHS
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QRough-in Inspection Required? ❑Yes �Io Inspection Other Than Rough-In:�eady Now �Will Call
_ 1 � ` �
You must call the inspector when ready! Date Ready:
I certity that I am the�LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Sit� �i�� �0�� ��l P� �n n` c� ri � o,�
Name
Harrison .1 , .
ractor, Company or Owner Perfor
3440 Kilmer L
r (Contractor or Owner Perfortninc
�2)
License Number I Master Electrician or Power
License Number
(2) Phone Numbers
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