P - 76409� 1-99�.�029 �
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Describe -uyfpg�cl of the wh�� e py if n
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GENERALFEES
SERVICES / POWER SUPPLIES
REQUEST FOR ELECTRICAL INSPECTION �`�
Minnesota Board of Electricity �
1821 University Avenue Suite S-128, Saint Paul, Mi�nesota 55104
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(651) 642-OS00 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
�- the work covered by this request: �
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Outdoor Lighting Standard $1
Traffic Si nal Standard $5
. � Suoolemental Fee C� $20
Above 200 Am ere a$10
ALARM, COMMUNICATION, REMOTE CONTROL, SIG
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 a(� $25
1 Home Park Lots
Vehicle Park Site
Transformer I Power Su I for S' ns I Outline L' htin $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circufts and Two Inspection Trips Each Dwelling Unit @$80
Additional Ins ction Tri s $20
Investi ative Fee
Reins ection Fee $20 �
TOTALFEE
(minimum total fee is $20) �
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I hereby certi(y that I inspected the electrical installation desaibed herein on the dates stated:
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S al Ins ion $.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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19920297 ����
Date: Rou h-in In dion R uired? ❑Yes No In
9 spe eq spec6on Other Than Rough-In: � Ready Now� Will Call
You must call the inspector when ready! Date Ready:
I ceRify that I am the �ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job S' eet A�dre � � / City
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Fire No. Counry
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Please Provide Two (2) Phone Numbers
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Please rovide Two (2) Phone Numbers Inc
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iLECTRICIN COPY F
Area Code