P - 77010; : � REQUEST FOR ELECTRICAL INSPECTION � �
i 1,� (,�, �# /.� � 0 1 � Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
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� (651) 642-0800 TTYIMRS 1-800-627-3529 www.electricity.state.mn.us
Describe -using the back of the white copy if necessary - the work covered by this request:
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GENERAL FEE Outdoor Liqhtina Standard (�a $1
0 to 400 Am ere +$25 C "
401 to 800 Am re $50
Above 800 Am re $75
CIRCUITS I FEEDERS
0 to 200 Am re $5
Above 200 Am ere $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S tem Device or A paratus $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Additional Unit (� $25
Retroffi
lanufactured Home Park Lots a$25
lecreational VehiGe Park Sites a$5
e arate Bondin Ins ection $20
'al Ins 'on $30 per Hour
pecial Ins on $.31 r Mile
� INSTALLATION MAY BE ORDERED DISCON
I IIII II III II �I II f�� II III II III II lil II III W� I�
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Transformers u to 10 KVA $10
Transformers over 10 KVA @$ 20
Transformer I Power Supply for Signs I Outline Lightinq $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
TOTAL FEE
total fee is $20) y. 50
that I inspecled Ne electrkal installa6on described herein on ihe dates stated: �
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WITHIN 12
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°"' Rough-in Inspection Required? ❑ Yes ❑ No Inspection Other Than Rough-In: � Ready Naw ❑ Wili Call
3��p — �, You must call the inspector when ready! Date Ready:
I certify that I am the [�CENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Sfte SVeet Address ��,
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Township Section Range Fire No. County '��c�F�„
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Owner/Occupant Name Please Provide Two (2) Phane Num rs Induding Area Code
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�.on[rac[or ucense rvumDer Master EleCtncian or Power Limited Tecfl I
► C. Zln C. C�� t� a License Number� Q �/
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ier Performing Installahon)
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'erform g Installatlon) Please Provide Two (2) Phone Numbers Induding Area G
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BOARD OF ELECTRICITY COPY parnmm �_� s.�'