P - 77362�" 7� 1 3 3 5 3 REQUEST FOR ELECTRI,C�AL INS�r�� ON
� � ❑ Minnesota Board of Electricity p(QOS— � �i�-
1821 University Avenue Suite S-128, Saint Paul, Minnesota 104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
Describe -using the back of the white copy if ne�egs,�[y��the �orkFqupfed,by�i�, ��upst, S S41 I TCH
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GENERALFEES
SERVICES I POWER SUPPLIES
0 to 400 Ampere $25
401 to 800 Am ere $50
Above 800 Am ere $75
CIRCUITS / FEEDERS
0 to 200 Am ere $5
Above 200 Am ere $10
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL F
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Lighting Retrofit (�a $.25 per Fixture
Outdoor Liahtina Standard
Supplemental Fee @ $20
Transformers up to 10 KVA @$10
Transformers over 10 KVA (�a $ 20
ONE 8 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 $20
Investigative Fee
Reins ection Fee $20
TOTAL FEE n O,� �`Li(�Q
(minimum total fee is $20) �
THIS AREA FOR INSPECTOR USE ONLV
I herebvi certifv thal I inspected the electrical installation described herein on the dates stated:
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Special Inspecfion @$30 per Hour ExaiaEO aeaNOONEO — onTE I
S ial Inspection $.31 er Mile
THIS INSTAlLAT10N MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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17813353
�� �`t� U`� Rou h-in Ins ection Re uired? ❑Yes
g p q No Inspection Other Than Rough-In: [�Ready Now ❑ Will Call
You must call the inspector when ready! ; Date Ready:
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I ce�tify that I am the u LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
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I Township ._ Section �-��Range �� Fire No ! County
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i Ay�lyized ' e(Contrector or Owner Performing Installation) �� P�2�F
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Numbers Including Area Code
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Master Elec[rician or
License Number
Numbers Including Area
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