P - 76876REQUEST FOR ELECTRICAL INSPECTION �
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❑ Minnesota Board of Electricit �- �
�'^ �� ( 1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
f� �" (651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us �6�i�
Describe - ing the k f 1he white copy if necessary - the work covered by this request:
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GENERAL FEES Outdoor Liahtino Standard (� $1
0 to 400 Ampere a$25
401 to 800 Am ere $50
Above 800 Am re $75
CIRCUITS I FEEDERS
0 to 200 Am ere $5
Above 200 Am re $10
ALARM, COMMUNICATION, REMOTE CANTROL,
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 Und (� S25
Irrigation Boom C
i Home Park Lots
Vehicle Park Site:
Supplemental Fee
Transfortners up tc
Transformers over
�NE & 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
Investigative Fee
Reins ction Fee $20
TOTALFEE
(minimum total fee is $20) Q
THIS FREA FOR INSPECTOR USE ONLY
I hereby certify that I inspected the electrical installation described herein on ihe dates stated:
5 ial Ins ion $.31 per Mile
IIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHI_N 12 MONTHS
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Rough-in Inspection Required? ❑ Yes �I No InspecGon Other Than Rough-In: ❑ Ready Now �Will Call
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You must call the inspector when ready! Date Ready:
I certity that I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
J Site Street Address �m,
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Township Sec' n Range Fire No. CounN �
� Mailing Address
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Electrical Utility Add
er �
;entral Ave NE
" 304
= ��ryyyqqqPerforming Installation)
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:t r Performing In Ilation)
Please Provide Two (2) Phone Numbers Including Area
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� e Nu r_ Master Electrician or Power Limited T
�, License Number
Please Provide Two (2) Phone Numbers Including Area
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