P - 77502REQUEST FOR ELECTRICAL INSPECTION �
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1-787-916 4 y ���
❑ Minnesota Board of Electricit ,
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 H�x•H.electricity.slate.mn.us
Descnbe -using the back of the vfiite copy if netass7ry.-,the wotk coverQA: by Shis request: _ _
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GENERALFEES
/POWER
Traffic Signal Standard
Suoplemental Fee an $
au i to uuu Hm re a� �bu Transformers u to 10 KVA $10
Above 800 Am re $75 Transformers over 10 KVA $ 20
CIRCUIT51 FEEDERS Transformer I Power Su pl for Si ns I Outline Li htin $5
b to 200 Am re $5 ONE & TWO FAMI�Y DWELLINGS, EACH UNIT
Above 2p0 Am re $10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALAFtM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit @$80
CiRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ection Tri s $20
Each System Device or A paratus @$.50 Investigative Fee
ADDITIONS TO THE GENERAL FEES Reinspection Fee @$20
W1lkTIfAMiLY DWELLINGS PER UNIT TOTAL FEE _?(�� o
3 to �2 Units @$50 Per Unit (minimum total fee is $20)
EeCll Additl0nel Ut1it @$25 THis naEa Foa iNSaECTOa usE or+�v
Retrofit
Park Lots
Park Sites
I hereby certify that I inspected the electrical installation described herein on the dates slated:
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Special Inspection @$.31 per Mile � �
S IAISTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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�� °"' '�I Rough-in Inspection Required? ❑ Yes �] No I Inspection Other Than Rough-In: [�`Ready Now ❑ Will Call
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I�' _ � 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:
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�,. OwnedOccupant Name Please Provide Two (2) Phone Numbers Including Area
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� Elec� tdca UI tility Electrical Utility Address
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��, Gpntractor / Company Name . Contractor License Number � Master Electrician or Power Limited T
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I �dailing Address (Contractor, Company or Owner Performing Installation)
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iAu�p�� Synature Conhactor or Owner Performin Installahon i Please Provide Two (2) Phone Ni
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Area Code
INSFRUCTIONS ON BACK OF YELLOW pOPY BOARD OF ELECTRICITY COPY Fa_nnmm�_�c a� �nne