P - 77118REQUEST FOR ELECTRICAL INSPECTION �'��
1� 8 2�'� 7$� � Minnesota Board of Electricity �- �
— 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
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(651)642-0800TTY/MRS1-800-627-3529wovw.electricity.state.mn.us ,6
Describe -using the back of the white copy if necessary - the work wvered by this request:
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GENERAL FEES Outdoor Lighting Standard $1
SERVICES I POWER SUPPLIES ?1 Traffic Siqnal Standard an. $5
Above 800 Am ere a$75
CIRCUITS I FEEDERS
0 to 200 Am re $5
Above 200 Am ere $10
ALARM, COMMUNICATION, REMOTE CANTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL
Lightinp Retrofit an $25 per Fixture
S ial Ins ection $.31 r Mile
THIS INSTALLATION MAY BE ORDERED [
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L8237826
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 Inspection Trips @ $20
Investiaative Fee
TOTAL FE j I �• �� I
total fee is $20
I hereby certify that I inspected the electrical installation described herein an the dates stated: �
NOT COMPLETED WITF
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Date: Rou h-in Ins ction Re uired? ❑ Yes o Ins
g pe q pection Other Than Rough-In: ❑ Ready Now �Will Call
��� ��' d� You must call the inspedor when ready! Date Ready: `t �� l� 0�
I certi(y that I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work al
Job Site Street Address City
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To ship Section Range Fire No. County
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Owner/Oxupant Name � Please Provide Two (2) P one Nu bers ncluding Area Code
� Contrador / Company
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�any or
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Master EleCtnCian or
License Number
Please Provide Two (2) Phone Numbers
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