P - 76604REQUEST FOR ELECTRICAL INSPECTION �� ��
1� 8 2 0� 4 0 2 � Minnesota Board of Electricity t �
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
Describe -using the back of the white copy 'rf necessary - the work covered by this request:
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GENERAL FEES Outdoor Liqhtinq Standard Cc� $1
0 to 400 Am ere $25
401 to 800 Am ere a$50
Above 800 Am ere a$75
CIRCUITS / FEEDERS
0 to 200 Am re $5
Above 200 Am re $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIG
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or A paratus $.50
' ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Unfts @$50 Per Unit
Each Additional Unit l�D $25
Park Lots a $25
Park Sites $5
: ctioo a $20
$30 per Hour
$.31 per Mile
ON MAY BE ORDERED
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18204024
Transformers u to 10 KVA $10
Transformers over 10 KVA @$ 20
Transformer I Power Supply for Signs / Outline Lighting $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
Addftional Inscection Trios Ccil $20
TOTAL FEE I �/ �D
total fee is $20)
I hereby certity that I inspeded the elecUical installation described herein on the dates stated:
ROUGH IN pq�
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FINFLINSPECTION DATE
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iNNECTED IF NOT COMPLETED WITHIN 12 MONTHS �_ ��
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ua[e: Rou h-in Ins �
g pection Required. �Yes ❑ No Inspectlan Other Than Rough-In: ❑ Ready Now�Will Call
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`�- �l a��(p You must rall the inspector when readyl Date Ready:
I certify that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY �"OWNER and hereby request inspection of the electrical work at
Job Site SVeet Address C�y
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31 ity ElecUical Utllity Ad�
3or / Company Name
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lJ�i9ress (ConVactor, Company or Owner Perfortning Installation;
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¢ed Signature (Contredor or r Pedorminn Installationl �
Please Provide Two (2) Phone
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License Number I Master Electrician or
License Number
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Please Provide Two (2) Phone Numbers I
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