P - 77035REQUEST FOR ELECTRICAk INSPECTION �
�;:
�� 9 2 4- 3 4 3� Minnesota Board of Electricity •�/)'')� �� � g �-: � �
1821 University Avenue Suite S-128, Saint F�auYMinnesota 104
- ��
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.stute.mn.us ��?
Describe -using the back of the white copy if necessary - the work cover�this r u st: �
2,g'la. \Y- �
GENERAL FEES Outdoor Liqhtinq Standard (�D $1
SERVICES / POWER SUPPLIES
0 to 400 Ampere a$25
401 to 800 Am re $50
Above 800 Am re $75
CIRCUITS / FEEDERS
0 to 200 Am ere $5
Above200Am ere $t0
ALARM, COMMUNICATION, REMOTE CANTROL, 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
Retroft
Transformers u to 10 KVA $10
Transfortners 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 and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Add'Rional Ins tion Tri s $20
Investi ative Fee
Reinspection Fee $20
TOTAL FEE �
(minimum total fee is $20)
mis aaEn voa iNSrecroa usE on�r
I hereby certiry that I inspeded the elecViral installation described herein on the dates slated:
Speciallnspection $30perHour exP�Reo�naa�aee
Special Inspection $.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF
i llll l l l l ll lll l l l l l l l l l l l ll l ll l l l l l ll l� l� l��
l, 9 2 4 3 4 3 5
I certify that I am
Job $ite Street Ad
����
APLETED WITHIN 12 MONTHS
Rough-in Inspection Required? ❑Yes �il'Flo Inspection OtherThan Rough-1 � eady Now ❑Will Call
i/�
You must call the inspector when ready! Date Ready:
VSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
(2) Phone
Number I Master Electrician or
License Number
Jumbers Including
� /