P - 77426REQUEST FOR ELECTRICA INSPECT � �
� � O 1` � - 5 � 5 � Minnesota Board of Electricity (�$— ���� � :�,
. 1821 University Avenue Suite 5-128, S�int aul, Minnesota 55104 �
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
Desc�ibe -using the b_ aack of the wh�copy if necessary - the work covered by this request: �
401 to 800 Am ere $50
Above 800 Am ere a$75
CIRCUITS / FEEDERS
0 to 200 Am ere $5
Above 200 Am re $10
ALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or A aratus $.50
ADDITIONS TO THE GENERAL I
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Add'Rional Unit kil $25
� THIS
Retrof�t
Traffic Si nal Standard $5
Su plemental Fee $20
Transformers u to 10 KVA u$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
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additional Inspection Trips @ $20
Investiqative Fee
TOTAL FE j I 2�•
total fee is $20 � �J
I hereby certify thal I inspected the eledrical installation described herein on the dates slated: �
ed Home Park Lots $25
al Vehicle Park Sites $5 Firu�u+saEC.iorv pA�
ondin Ins 'on $20 _ �, ��D
�ection $30perHour ExvmEOiaennoowEO pq�
�ection $.31 r Mile
�LLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
II,
IIII �II�� E�lil IIIII IIIII IIIII IIIII IIIII �IN I�I
181�2�856
ua�e: ^ Rou h-in Ins ction R uired?
(� � 9 pe eq ❑ Yes No Inspection Other Than Rough-In: Ready Now ❑ Will Call
� You must call Ihe inspector when ready! Date Ready:
I certify that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Site Street Addr�s,y � , „ r;�„ _ .,
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or
ElecVical
Eiect. Inc,
Mmer Perfortning Installador
ner Lan� N.
License Ni
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Pleas�
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Two (2) Phone Numbers Including Area
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Master ElecVician or Power
License Number
Two (2) Phone Numbers Including Area
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