P - 77107� H� 6 7 O 3 �, REQUEST FOR ELECTRICAL INSPECTION ������
� �s ❑ Minnesota Board of Electricity � � ;�
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 '�
(651) 642-0800 TTY/MRS 1-800-627-3529 wxtiv.elec�ricity.state.mn.us ��,�
Descnbe -using the back of the white copy if necessary - the work covered by this request: L✓ , A�� �� ���I
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GENERAL FEES Outdoor Liqhtinq Standard (� $1
0 to 400 Ampere a 3"
401 to 800 Am ere $50
Above 800 Am ere $75
CIRCUITS I FEEDERS
0 to 200 Am ere $5
Above 200 Am re $10
ALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Liqhtinq Retrofit (� $.25 per Fixture
Hour
Mile
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18467035
Transformers u to 10 KVA $10
Transformers over 10 KVA @$ 20
Transfortner / Power Supply for Signs I Outline Lighting @$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
InGudes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
total fee is $20) I�C./� J�
that I inspeded the eledrical installation described herein on the dates stated:
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Date: � Rough-in Inspection Required? ❑Yes � Inspection Other Than Rough-In: B Ready Now ❑ Will Call
w ou 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 Site Street Addre/� /�� y� C�tY� ^
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Utility Address
11967 Eidorado St�Nt Nt
Please Provide Two (2) Phone Numbers InGuding Area Co
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tse� ¢ern _ Master Electncian or Power Limited Ted
� / i License Number
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Please Provide Two (2) Phone Numbers Including Area Ca
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