P - 76370REQUEST FOR ELECTRICAL INSPECTION
2����� 2 6 5� Minnesota Board of Electricity �;
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �
� � (651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
g�scnbe -using the back of the white copy if necessary - the work covered by this request:
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GENERAL FEES Outdoor Li htin Standard @$1
SERVICES I POWER SUPPLIES Traffic Signal Standard $5
0 to 400 Amcere (�D $25 Suoolemental Fee la� $20
401 to 800 Am ere $50
Above 800 Am re $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
Each S stem Device or A paratus $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Center Pivot Irrigation Boom �
Manufactured Home Park Lots
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 fee is $20) ���1
I inspected the elechical inslallafion described herein on the dates stated: �
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THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
Y �-EVc „a�_�:
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Date: Rough-in Inspection Required? ❑ Yes �No Inspection Other Than Rough-In: ❑ Ready Now�lVill Call
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�' ' You must call the inspector when ready! Date Ready:
i certiTy that I am the �CICENSED CONTRACTOR 0 COMPANY ❑ OWNER and hereby request inspection of the elecUical work at
Job Site Street Address Cit I
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�se Number Master Electridan or P�
� License Number
Please Provide Two (2) Phone Numbers I
�03�?5�-(o�c�)