P - 77527REQUEST FOR ELECTRICAL INSPECTION
1��� 1- 914 �9 Minnesota Board of Electricity ;r-
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-500-627-3529 www.eleclriciry.state.mn.us
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SUPPLIES
10
FEES Outdoor Lightin Standard @ $1
Traffic Signal Standard @ $5
Supplementai Fee @ $20
Transformers u to 10 KVA $10
Transformers over 10 KVA $ 20
Transformer I Power Su I for Si ns I Outline Li htin $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit @$80
;UiTS, CIRCUITS OF LESS THAN 50 VOLTS
Each �stem Device or Apparatus @ $.50
ADDITIONS TO THE GENERAL FEES
fIFAMILY DWELLINGS (PER UNIT)
3 to 12 Units @$50 Per Unit
i Boom @
Park Lots �
Park Sites
Investigative Fee
Reinspection Fee $20
TOTALFEE ^rjef;*i
(minimum total fee is $20)
THIS AREA FOR INSPECTOR USE ONLV
I hereby certify that I inspected the electrical installation described herein on the dates stated�
ROUGHIN DATE
FINALINSPECiION — DATE
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5 ial Ins ction @$31 per Mile
TH1S INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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°"� f i Rough-in Inspection Required? ❑ Yes �] No I Inspection Other Than Rough-In: [�Ready Now ❑ Will Call
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T_ __, ___. __ __LYou must call the inspector when ready! ; Date Ready:
I ce�ify that I am the L�] LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
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��. Opner/Qccupant Name -- � -�- I Please Provide T�I o(2) Phone Numbers Includin Area Code
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'� Gpniracbr / Canpany Name ., Contractor License Number Master Electrician or Power Limited Technic
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Maling Addressr(Contrector Company or Owner Performing Installahon) I � � � - � � �� � � � �---�
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�� Aythorizetf Si nsture (Contractor or Owner Performing Installation) � � � Please Provide Two (2) Phone Numbers Including Area Code
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Nf3TRUCTIONS pN BACK OF YELLOW COPY __ _ BOARD OF ELECTRICITV COPY co n..,.,,,. ,� e