P - 76875REQUEST FOR ELECTRICAL INSPECTION �`� �-
th� a Minnesota Board of Electricity �' �
��� � 1�� J� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.0
Describe -using the back of the white copy if pe�ssary - the work coy�red by this request:
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SERVICE51 POWER SUPPLIES
0 to 400 Ampere $25
401 to 800 Am re $50
Above 800 Am ere $75
CIRCUITS / FEEDERS
0 to 200 Am re $5 �}
Above 200 Am re $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Additional Unit C� $25
Center Pivot Irrigation Boom �
Manufactured Home Park Lots
Recreational Vehicle Park Site:
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INSTALLATION MAY BE ORDERED I
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Transformers u to 10 KVA $10
Transformers over 10 KVA $ 20
Transformer / Power Su I for Si ns / Outline Li htin $5
ONE 8 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 Inspeclion Tri s $20
Investigative Fee
Reins ection Fee $20
TOTAL FEE /D
(minimum total fee is $20) �Q, 3
THIS AREA FOR INSPECTOR USE ONLV
I hereby cert"rfy that I inspected the elecVical installa6on described herein on the dates stated:
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IF NOT COMPLETED WITHIN 12 MONTHS
REC'D MAY � � 2�1� c�Q�
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�ough-in Inspection Required? ❑Yes �o Inspection OtherThan Rough-In: Ready Now ❑Will Call
You must call the inspector when ready! Date Ready:
JSED CONTR,4CTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
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Section Range Fire No. County
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Please Provide Two (2) Phone Numbers Including Area Code
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E ec rical Utilitv Address
or
_icense Number Master Electrician o ower Limited T�
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Please � ovide Two (2) Phone Numbers Including Area C
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