P - 77722I _� REQUEST FOR ELECy RICP�L IC_ N�PECIIQt�S �
1� C's � O� 3 5 8 Minnesota Board of Electricit O( �� �a.�� y `:
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �°
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us ��' "
Describe -usi �ne back e white co y if necessarv - the work cov,ered bv this reauesTl _
� I SERVICES / POWER SUPPLIES
0 to 200 Am ere $5
Above 200 Am ere $10
ALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or Ap aratus $.50
ADDITIONS TO THE GENERAL I
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Add'Rionai Unit @ $25
OTHER ADDITIONAL FEES
Liqhtinq Retrofit (�a $.25 oer Fizture
THIS IN;
" Outdoor Lighting Standard $t
Traffic Si nal Standard a$5
Su plemental Fee a $20
Transformers u to 10 KVA $10
Transformers over 10 KVA $ 20
Transfortner I Power Su I for S' ns I Outline Li htin $5
ONE & 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 Ins ection Tri s $20
Investi ative Fee
Reins ection Fee a $20
TOTAL FEE
(minimum total fee is $20) �
I hereby certify that I inspeded the electrical installation described herein on the dates stated: �
Ll
�CfiOn $30 @fHOUf e�criaEOrnewaooNeo
�ction a� $.31 per Mile
.LATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITF
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� You must call
I certify that I am the LICENSED CONT
Job Site Street Addre s ._�
1s�� l�
I ElecVical
9 Coon Rapids Bivd.
--c. � O �( � ' G �,
onre
72 MONTHS
6'd? Inspection OtherThan Rough-In: Ready Now ❑Will Call
when ready! Date Ready:
7�1A�PANY OWNER and hereby request inspection of the electrical work at:
Utility
Fire No. County
Please Provide Two (2) PI
( .�i►"�/—C
O)
mascer eiecuiaan or
License Number �
Provide Two (2) Phone Nur
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