P - 76630REQUEST FOR ELECTRICAL INSPECTION � �
2� 0 6��, �� 4 �„ 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
�nbe -usinJthe k of the white copy if necessary - the work covered by this request:
„��,t�, � � /. : �,-_ .,. �.�,� � -�'1-1-, _ "1 iF ��
0 to 400 Ampere �$25
401 to 800 Am ere $50
Above 800 Am ere a$75
CIRCUITS I FEEDERS
0 to 200 Am re $5 �
Above 200 Am ere $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Ap aratus $.50
ADDITIONS TO THE GENERAL FEES
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL
Liqhtinq Retrofd (� $.25 cer Fixture
Traffic Siqnal Standard
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 fee is $20) I �!� .�----
I inspeded Me electrical installation desaibed herein on the dates stated: I
5 ial Ins ion $30 per Hour exrrEOinawoor�o
Special Inspection @ $.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITf
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DATE
t MONTHS________
ua[e: Rough-in Inspection R uired?
��I � �� eq ❑ Yes No Inspection Other Than Rough-In: ❑ Ready Now ill Call
i
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 at
Job Sde SVeet Address Ciry
� 1f'�C.iC ov �-� %� d. �
Township Section Range Fire No. Coun
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Owner/Occupant Name Please Provide Two (2) Phone Numbers Including Area Code
t \ V1/\C� �1����.�� �i763�5(aC)< <.L�ll�� )
Electrical Utllity Electrical l
Center oint E ergy
Contrador/Compa��2 C�ntrai Ave
Anoka, MN 55304
Mailing Address (Contrector,��1���6y�� ing In:
or
ise Number Master Eiectrician or Power Limi[ed Techni
�,�y � License Number
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Please Provide Two (2) Phone Numbers Including Area Code
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