P - 77109� REQUEST FOR ELECTRICAL INSPECTIO��� � ���'��
�`� J L 1- 211 � Minnesota Board of Electricity k
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �`
(651)642-0800TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us �:���
Describe -using the bac the white coRy i�ecessa - he work co^ �� by this req st: �
� 4 i / Y �
GE ERAL FEES Outdoor Li hting Standard $1
SERVICES / POWER SUPPLIES Traffic Si nal Standard $5
0 to 400 Ampere $25 Supplemental Fee $20
401 to 800 Am re $50 Transformers u to 10 KVA $10
Above 800 Ampere C� $75 Transformers over 10 KVA (a� $ 20
Above 200 Am ere $10
ALARM, COMMUNICATION, REMOTE CONTROL
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 Units (� $50 Per Unit
)DITIONAL FEES
Fixture
Manufactured Home
Recreational Vehicle
Special Inspection @ $30 per Hour
Special Inspection $.31 per Mile
THIS INSTALLATION MAY BE ORDERED I
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19272111
ONE & 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
Investi ative Fee
Reins ction Fee $20
TOTAL FEE
(minimum total fee is $20) ; , ��
I hereby certiry that I inspected the electrical installation described herein on the dates stated: �
__�—� <----" / l-- (,6. '
�" DATE
COMPLETED WITHIN 12 MONTHS
� Rough-in Inspection Required? ❑ Yes�No Inspection Other Than Rough-In�eady Now ❑Will Call
�' vS You must call the inspector when ready! Date Ready:
� � �' ,
I cert'rfy that I am the.�iCE1Q5EQ�ONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Jpq ite Str�Address C �
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Township ection Range Fire No. C unty
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Utility
,., Co License Numbe Master Eledrician or Power Limited Technician
G License Number
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g Installation) Please Provide Two (2 Pho Numbers InGuding�Area Code
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