P - 77488REQUEST FOR ELECTRICAL INSPECTION ��°,. .,
1 � � � � � (� � � � Minnesota Board of Electricity ;r;- �
� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 _
(651) 642-0800 TTY/MRS 1-800-627-3529 x�u�ir.electricitv.state.mn.us
Describe -using the back of the white copy if ne, s ar�! -.the �r4c,�pye,�eA, by.t�i Q uest .,
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. GENER4L FEES Outdoor Lighting Standard $1
SERVICE$ I POWE SUPPUES Traffic Signal Standard @$5
0 to 400 Am re $25 Supplemental Fee @$20
401 to 800 Am re $50 Transformers u to 10 KVA $10
� Above 800 Ampere @ $75 �
CIRCUfTSI FEEDERS
0 to 200 Ampere @ $5 �-��
T Above 200 Ampere a(�$10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL FEES
$50 Per Unit
Unit @ $25
Retrofit @ $.25 per Fi;
'ivot Inigation Boom �
tured Home Park Lots
�nal Vehicle Park Site:
Transformers over 10 KVA $ 20
Transformer I Power Su I for Si ns / Outline Li htin $5
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 a� $20
� Investiqahve Fee
total fee is $20) � ��• j�
I inspected the eledrical installation described herein on the dates stated:
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a ua u�speccion L y.su per rtour tXh'IRE�/ABAND�NED DAiE
Special Inspection @ $.31 per Mile
!fS ItJSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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L7879222
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I Rough-in Inspection Required? ❑Yes ��] No I Inspection Other Than Rough-In: [QReady Now OWill Call
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You must call the inspector when ready! ; Date Ready:
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I certity that � am the �] LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
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�i Job Site StrEet Address - ----�- � �- — --- - - - �- - � — ---� --
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, OwnedOccupant Name � � � ��
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,,� Range I Fire No.
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me Numbers
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� �;"�'"�" V°"� ' Electrical Utility Address �
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tractot / Company Name — — —
Contrector License Number TMaster Electrician or Power
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Ddailing AddresS (Contractor, Company or Owner Performing Installation) - -- �-� -�� — —
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iAushoraed S' nature (Conhactor or Owner Performing Installation) - i Please Provide Two (2) Phone Numbers Incluc
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�NSiRUCT10N5 ON BACK OF YEILOW COPY BOARD OF ELECTRICITY COPY _ FR_r
Area
Area Code