P - 77354Q REQUEST FOR ELECTRICAL INSPECTION "
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�� 1,O �- 3 3 9 5� Minnesota Board of Electricity p�(,(�S —v �� �� ' _;�;
1821 University Avenue Suite S-128, Saint Paul, Minnes 5 4
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricilv.state.mn.us
uescnde -using the back ot the white copy it na��the
GENERALFEES
SERVICES I POWER SUPPLIES
0 to 400 Amnere la� $25
Above 200 Am ere $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIG
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
'adured Home Park Lots $25
ational Vehicle Park Sites $5
ate Bondin Ins ection $20
al Inspection @ $30 per Hour
al Inspection $.31 er Mile
STALLATION MAY BE ORDERED
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17813395
����'S SWITCH
Outdoor Lighting Standard
Traffic Signal Standard @ ;
Suoolemental Fee na $20
Transformers over 10 KVA $ 20
Transformer I Power Su I for Si ns / Outline Li htin $5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additional Ins ection Tri s $20
Investigative Fee
Reins ection Fee @ $20
TOTALFEE
(minimum total fee is $20) 2�• 5�
THIS AREA FOR INSPECTOR lISE ONLY
I hereby certify that I inspected the electncal installation described herein on the dates stated:
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CONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
I� "�� +=`� � �1 � 'i Rough-in Inspection Required? ❑ Yes
, �] No Inspection Other Than Rough-In: [�Ready Now ❑ Will Call
� � You must call the inspector when ready! �I. Date Ready:
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I certify that I am the Ll LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
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Section I Range '�I Fire No.
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Vumbers Including Area
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i ElecVical Utiht � Electrical U[ility Address
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�� �����5'���� GO�iF`��{�1T 1 i�� Contractor �se(�� j ; Master Elechician or Power Lirr
� ' License Number
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. Malin Address Contrector Com any or Owner Performin Installahon
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. A�Qypr¢ed ' t e(Contractor or Owner Performing Installation) �- ��� � P��q pr�i��di.(P�) �I�jne Numbers Including
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INSTRUCTIONS ON BACK OF YELIOW COPY BOARD OF ELEC7RICITY COPY EB-0000