P - 76410` /� (] REQUEST FOR ELECTRICAL INSPECTION �'�
1� 9 8 2�`t ��.J � Minnesota Board of Electricity ��� °�
� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 :�'
(651)642-0800TTY/MRS1-S00-627-3529www.electriciry.state.mn.us �"'"�
Oes�sing fie back of the white copy if necessary - the work covered by this r quest:
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GENERAL FEES Out or Li hting tandard $1
SERVICES / POWER SUPPLIES Tra�c Signal Standard $5
0 to 400 Ampere $25 Supplemental 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 I FEEDERS Transformer I Power Su I for Si ns / Outline Li htin $5
0 to 200 Am re $5 ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere $10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CANTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit @$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or Apparatus $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Additional Unit l� $25
Home Park Lots @ 9
'ehicle Park Sites
iing Inspection @ $2
iion @ $30 per Hour
2ion (� $.31 per Mile
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I certify that I am the I
Job Site Street Address
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Township
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Owner/Occupant Name
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Address
i Fee $20
TOTALFEE �
inimum total fee is $20) �
THIS AREA FOR INSPECTOfl USE ONLY
I inspeded the elecUical installation describ�heFelfi on the�datesTated:
DATE
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Rough-in Inspection Required? ❑ Yes ❑ No Inspection Other Than Rough-In: � Ready Now �Will Call
You must call the inspector when ready! Date Ready:
VSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
� City _ �
Sec[lon Range Fire No.
Please 1
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Electrical Utility Address
Contractor License Num
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�any or wner Perfortning Installation)
�- - a -� - ��.��. r � �
� or wner Performina Installationl �w�
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Master Electrician or P
License Number
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Numbers
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