P - 77143REQUEST FOR ELECTRICAL INSPECTION `�
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1� J�� - 4 4 3 0 Minnesota Board of Electricity k �
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �
(651)642-0800TTY/MRS 1-800-627-3529 www.electricity.state.mn.us �,��
Describe -using the back of the whitG copy if necessary - the worJc.r�overed by this request: , _
I SERVICES I POWER SUPPLIES
Above 200 Am ere $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or Apparatus @$.50
ADDITIONS TO THE GENERAL FEES
Each Additional Unit
Center Pivot Irrigation Boom C
Manufactured Home Park Lots
THIS INSTALLATION MAY BE ORDERED DISCONI
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L9244433
Traffic Si nal Standard a$5
Su plemental Fee $20
Transformers u to 10 KVA $10
Transformers over 10 KVA $ 20
Transformer / Power Su I for Si ns / 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 a$20
Investigative Fee
Reins ection Fee $20
TOTALPEE
(minimum total fee is $201 c
I herebvi certiN that I inspected the electrical installation described herein on the dates slated: �
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:D IF NOT COMPLETED WITHIN 12 MONTHS
Date: Rough-in Inspection Required? ❑ Yes o Inspection Other Than Rough-In: �Ready Now ❑ Will Call
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,'�Z� O You must call the inspedor when ready! Date Ready:
I certify that I am
Job Site Street Ad
Mailing A�
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Authorized
or
CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
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Perfortning I
Fire No. Count '
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Please Provide Two (2) Phone Numbers Including Area Code
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�r License N m r Master Electrician or Power Limited Techni
License Number
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PI ase Provide Two 2) Phone Numbers Including Area Code
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