P - 77494REQUEST FOR ELECTRICAL INSPECTION ` ��
���� 1- 9 3 5 4� Minnesota Board of Electricity rs- -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/M RS 1-800-627-3529 www. electricity. state. mn. us
Descnbe -using the back of the white copy if ne�s�a�c_,theW�� �,by ihig �Q�u�st; ,_ _
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GENERALFEES
to
Above 200 Ampere �a $10
ALARM, COMatUNICATION, REMOTE CONTROL, SIG
GftCU1TS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMItY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Irrigation Boom �
i Home Park Lots
Vehicle Park Site.
Outdoor Lightin Standard @ $1
Traffc Signal Standard @ $5
Supplemental Fee @ $20
Transformers u to 10 KVA $10
Transformers over 10 KVA $ 20
Transformer / Power Su I for Si ns I 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 Insoection Trios Ccil $20
Fee
TOTAL FEE ;'.��.; a
total fee is $201
i inspected lhe elecMcal installation descnbed herein on ihe da�es stated:
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Spec�al Ins ectron �$30 per Hour exviHm nanNOOr�EO oqTE
S ial Inspection @$.31 per Miie
TH{S INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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��I vaSe: I Rou h-in Ins ection Re uired? ❑Yes p g [�Read Now
,, ,,,. ,� :, F'3+ 'i g . p q �] No � Ins ection Other Than Rou h-In: y ❑ Will Call
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� __ _ __ I You must call the inspector when ready! I Date Ready:
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I certify that I am the L'�j LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
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I Please Provide Two (2) Phone Numbers Including Area Code
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I Contrector / Companx Name � -� �� Contractor License Number i Master Electrician or Power Limited Technician
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Maibn�Address jContractor Company or Owner Performiny Ins[allahon � �� � � - - � �- - � ���� �-- -
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At�p rized 5� nature (Contractor or Owner Performing Installation) -� �? Plfease Provide Two (2) Phone Numbers Including Area Code
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