P - 77507REQUEST FOR ELECTRICAL INSPECTION =�
1����- 917 � Minnesota Board of Electricity ;
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTYIMRS 1-800-627-3529 k�Nnv.elech�icity.stale.mn.us
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GENERAL FEES Outdoor Li htin Standard $1
SERVICES I POWER SUPPLIES Traffic Siqnal Standard iU $5
avi ro uuu Hm ere a� y5u Transformers u to 10 KVA $10
Above 800 Am re $75 Transformers over 10 KVA $ 20
CtRCUITS ! 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 re $10 Includes the Service andlor Power Supply up to 500 Amperes, All
AL.ARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit @$80
GIRCUiTS, CIRCUITS OF LESS THAN 50 VOLTS Additional Inspection Tn s $20
Each S siem Device or Apparatus $.50 Investigative Fee
ADDITIONS TO THE GENERAL FEES Reinspection Fee $20
MULTIFAMILY DWELLINGS PER UNIT TOTAL FEE -'?t ��,.;
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3 to 12 Units @$50 Per Unit (minimum total fee is $20)
E2Ch Addifi0n21 U�it @ $25 rHisnaEnFOaiNSaecroRUSEON�v
Park Lots (
Park Sites
I hereby certify that I inspected the electrical installation described herein on the dates stated:
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Specwl Ins ction @$.31 per Mile
TH1S INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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� i�. F� , r' ' 'i Rough-in Inspection Required? IJ Yes {] No I Inspeclion Other Than Rough-In: [�Ready Now ❑ Will Call
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, _ _ I You must call the inspector when ready! I Date Ready:
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I certify that I am the L�`] LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
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' O}vnedOccupan(^[ Name � F i Please Provide Two (2) Phone Numbers Including Area Code
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il Electncal Utility Electrical Utility Address
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I Contractor / Company Name -- �� �Contractor License Number �.: Master Electrician or Power Limited Technici
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�Mailirt$AddressSContractor Company or Owner Performing Installation, � - - - �- �- -� � -
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inzed S' nature (Contractor or Owner Performing Installation) �� -� '�. Please Provide Two (2) Phone Numbers Including Area Code
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NIS7RUCTIONS QN BACK OF YELLOW COPY BOARD OF ELECTRI�ITV �f1PV �o nnnn, �,� o..,