P - 77485(� Q REQUEST FOR ELECTRICAL INSPECTION �`�
2� V 8 1� 0 7 6 Q Minnesota Board of Electricity �`p �
❑ 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �`�
�� ( (651) 642-0800 TTY/MRS 1-800-6273529 www.electricity.state.mn.us ?�t�
Describe -using e- ack of the white copy if necessary - the work covered by this request:
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GENERAL FEES Outdoor Lightin Standard @$1
SERVICES / POWER SUPPLIES Traffic Sipnal Standard an. $5
CIRCUITS / FEEDERS
0 to 200 Am re $5 (' �
Above 200 Am ere a$10
ALARM, COMMUNICATION, REMOTE CONTROL, SIG
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each AddRional Unfl (� $25
Irrigation Boom @
i Home Park Lots i
Vehicle Park 5ites
Transformer / Power Su I for Si ns / 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 Ins ion Tri s $20
Investi ative Fee
Reinspection Fee $20
TOTALFEE
(minimum total fee is $20)
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I hereby certify that I inspected the elecVical installation described herein on the dates staled:
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FINPL�NSPECTION . p�7E
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THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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vaie: Rou h-in Ins ection R �
g p equired. ❑Yes No Inspection Other Than Rough-In: ❑ Ready Now Will Call
" p� V� O� You must call the inspector when ready! Date Ready:
I certify that I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work ak
Job Site Street Address City �
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Township Secti n Ranae Fire No. Countv .
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G tractor / Company Name
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Mailing Address (Contractor, Company or
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rac r License
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Master Electncian or Power Limited Technician
License Number
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