P - 77603REQUEST FOR ELECTRIC L IN E T `�
1� 8�� o�� 8� Minnesota Board of Electricity p�Q�����C� "- � 4 ��
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104 .� ��
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us
� SERVICES / POWER SUPPLIES
0 to 400 Amcere (� $25
Above 200 Am ere a$10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Apparatus a(� $.50
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIO
Liqhtinq Retrofit an $.25 per Fixture
Special Inspection @ $30 per Hour
Special Inspection @ $.31 per Mile
THIS INSTALLATION MAY I
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L8556084
Outdoor Lightin Standard a $1
Traffic Signal Standard $5
Supplemental Fee $20
Transformers u to 10 KVA $10
Transformers over 10 KVA $ 20
Transformer / Power Su I for Si ns / Outline L' htin $5
ONE & 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 Ins ection Tri s a$20
Investigative Fee
Reins tion Fee $20
TOTALFEE ` C
(minimum total fee is $201 � � �
I hereby certify that I inspected the elecMral installafion descnbed herein on Ne dates stated:
IF NOT COMPLETED WITHIN 12 MONTHS
Date: � Rough-in Inspection Required? ❑Yes �No Inspection OtherThan Rough-In�'R��dy Now ❑Will Catl
You must call the inspector when ready! Date Ready: �3' �
I certi(y that I am the ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Site Street Address ' ��Y
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Townshio Section Range Fire No. County �� ���„ .
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Installation)
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License Number Master Electrician or Power Limited
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