P - 77643REQUEST FOR ELECTRICAL INSPECTION ���"�
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1_ 8 1�� 6 O 7 Minnesota Board of Electricity k S,,
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 `�.: -�;
(651) 642-0800 TTYIMRS 1-800-627-3529 www.electricity.state.mn.us ���
D,e,scf 'be -using the qack of the white copy if necessary - the work covered by this request: /� /
/`�e � cE e--�cc�tecL �ra � �tJr rilM L�J �� r� h e� u�i "T��l .
GENERAL FEE Outdoor Li hting Standard @$1
SERVICES I POWER SUPPLIES Traffic Si nal Standard $5
0 to 400 Ampere @$25 Suo�lemental Fee C� $20
401 to 800 Am re $50
Above 800 Ampere $75
CIRCUITS / FEEDERS
0 to 200 Am re $5
Above 200 Am re $10
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCUITS, CIRCUtTS OF LESS THAN 50 VOLTS
Each S stem Device or A aratus $.50
ADDITIONS TO THE GENERAL F
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units @$50 Per Unit
Each Addftional Unit @ $25
OTHER ADDITIONAL FEES
Li htin Retrofit @$25 r Fixture
Center Pivot Irriqation Boom Cc� $40
Special Inspection $30 per Hour
S 'al Inspectio� $.37 per Mile
THIS INSTALLATION MAY BE ORDERED
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La�a�6o��
�nsformers over 10 KVA @$ 20
�nsfom�[.(power Supply for Signs / Outline Lighting @$5
FAMILY DWELLINGS, EACH UNIT
> the Service and/or Power Supply up to 500 Amperes, All
and Two Inspection Trips Each Dwelling Unit @$80
i�i jnspection Trips @ $20
esti ive Fee
TOTALFEE
total fee is $20)
I inspeded the elecUical installation described herein on the dales stated:
1„ onre
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COMPLETED WITHIN 12
' { Rough-in Inspection Required? �Yes ❑ No Inspection Other Than Rough-In: � Ready Now�Will Call
/o ^` [ O� You must call the inspector when ready! Date Ready:
I certify that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Ske Street Add�ess ,
City
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Township Section Range Fire No. County
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Owner/Occupant Name Please Provide Two (2) Phone Numbers Including Area Code
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ElecUical U61ity �� ElecVical U' Add�� �� /�/ �`�/��
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Contra / om ny me Contractor License Number Master Electrician or Power Limited Technici
�� / e C� �� C,�aa 1G�3 License umber � 3js,
din Address (ConUa o, C mp ny or Owner erforming Instal tion)
�as7�l�,�ve��
or Owner Performing Installation) Please Provide Two (2) Phone Numbers Including Area C/
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� COPY BOAR� OF ELECTRIrITV f:(lPV � .. .......... . �