P - 77166REQUEST FOR ELECTRICAL INSPECTION �-V
1 �,C� � '1 0 /I � � � Minnesota Board of Electricity �
.7 1. `-f 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
Describe -using the back of the white copy if necessary - the work covered by this request: ��� ' )
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GENERAL FEES Outdoor Li htin Stan rd $t
SE ICES I POWER SUPPLIES Traffic S' nal Standard $5
0 to 400 Am re $25 ° Supplementai Fee $20
401 to 800 Am re $50 Transformers u to 10 KVA $10
Above 800 Am re $75 Transformers over 10 KVA $ 20
CIRCUITS / FEEDERS Transformer I Power Su I for Si ns I Outiine Li htin $5
0 to 200 Am ere $5 � ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re$10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM. COMMUNICATION. REMOTE CONTROL. SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit @$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or Apparatus @$.50
ADDITIONS TO THE GENERAL I
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Unfts @$50 Per Unit
Manufactured Home Park Lots $25
Recreationai Vehicle Park Sites �$5
Se arate Bondin Ins ection $20
S ial Ins 'on $30 per Hour
S ecial Ins ection $.31 per Mile
THIS INSTALLATION MAY BE ORDEREC
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�,9214709
TOTALFEE
total fee is $20) �d•�0
I herebVi certi(y that I inspected the electriral installatian described herein an the dates stated: �
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�a Rough-in Inspection Required? ❑ Yes I�(Jo Inspedion Other /Than ugh- eady N ❑ Will Call
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�� �`� �� You must call the inspector when ready! ` Date Ready: s
I certify that I am the.�'�CENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby req st inspection of the electrical work at
Job Site Street Address � , , City ,
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Township Secfion Range Fire No. County
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Oxupant Name Please Provide Two (2) Phone Numbers Includirg Area C e
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License Number Master Electncian or Power Limited Ti
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P ase Provid Two (2) Phone Numbers Including Area i
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