P - 76377REQUEST FOR ELECTRICAL INSPECTION °` ��
2! 0 2„i, �� 9�, Q', Minnesota Board of Electricity ��
� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
���I �b (651)642-0800TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
Des '-using the back of the white copy if necessary - the work covered by this request:
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�' GENERAL FEES Outdoor Li hting Standard $1
SERVICES I POWER SUPPLIES ° Tre�ic Si nal Standard @$5
0 to 400 Ampere a�. $25 Supplemental Fee @$20
Above 200 Am ere a$10 �
ALARM, COMMUNICATION, REMOTE CANTROL, SIG!
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus $.50
ADDITIONS TO THE GENERAL FEES
3 to 12 Units @$50 Per Unit
Each Additionat Unit @ $25
OTHER ADDITI01
Liqhtinq Retrofrt (a� $.25 per Fixture
Special Inspection @ $30 per Hour
S ecial Ins ion $.31 per Mile
THIS INSTALLATION MAY BE ORDERED D17
I IIII II III II ��I II III II ��I II III II III II (II �� I�
� � 2 4 5 9 4 0
� Transformer I Power Supply for Signs I Outline Lighting @$5
DNE & 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
total fee is
that I inspected the electrical installation described herein on Ne dates stated:
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NNECTED !F _NOT COMPLETED WITHIN 12
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Date: / Rough-in Inspection Required? ❑ Yes �No Inspedion Other Than Rough-In: ❑ Ready Now �Will Call
`� J� ���" You must call the inspector when ready! Date Ready:
I certify that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job SRe SVeet Address C�Y
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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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Electrical Utility Electrical Utility Address
ntral Ave NE
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� �� � License Number
Please Provide Two (2) Phone Numbers Including Area
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