P - 76405REQUEST FOR ELECTRI�j�L I SP ION / -� �
2 � � O �., `� 3 � 7 � Minnesota Board of Electricity }—� ����� � �-: �
1821 University Avenue Suite S-128, S�ai�t aul, M nnesota 55104 .�
, (651)642-OSOOTTY/MRS 1-800-627-3529 www.electrieity.state.mn.us
Descnbe -using the backof the white copy' necessary - work covered by this request:
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GENERAL FEES Outdoor Lightin Standard @$1
SERVICES I POWER SUPPLIES Traffic Si nal Standard $5
0 to 400 Ampere $25 Su lemental Fee $20
401 to 800 Am re $50 Transformers u to 10 KVA $10
Above 800 Am ere $75 Transformers over 10 KVA $ 20
CIRCUITS / FEEDERS Transformer I Power Su I for Si ns / Outline Li htin $5
0 to 200 Am re $5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re $10 Includes the Service and/or Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CANTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unft @$80
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 an $25
I Home Park Lots
Vehicle Park Site:
Special Ins ection $.31 er Mile
THIS INSTALLATION MAY BE ORDERED
IIIII IIIII Illi� Iliil EIIII IIIII IIIII IIIII �In i�
L1013677
Fee @ $20
TOTALPEE
iimum total fee is $20)
I hereby certity that I inspeded the electrical installation described herein on the dates stated: �
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' NOT COMPLETED WITHIN 12 MO�
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L°`�' ��/� � Rough-in Inspection Required? ❑ Yes �lo Inspection Other Than Rough-In: ❑ Ready Now ill Cal�
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You must call the inspector when ready! Date Ready:
1 certify that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspecti of the electrical work at
Job Site Street Address
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Contra or License Number Master ElecVician or
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Including Area C
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Please Pra�fe Two (2) Phone Numbers Including
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