P - 765531� 7 H 1- 917 8� REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 wwm.electriciry.slute.mn.us
Descnbe -using the back of the white copy if necessa the work covered by this re uest:
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GENERAL FEES Outdoor Li hting Standard @$1
SERVICES I POWER SUPPLIES Traffic 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 re $75 Transformers over 10 KVA $ 20
CIRCUITS I FEEDERS Transformer I Power Su I for Si ns I Outline Li htin $5
0 to 200 Am re $5 ,.� -'f— ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re $10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit @$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Insoection Tnos (a? $20
ADDITIONS TO THE GENERAL FEES
TIFAMILY DWELLINGS (PER UNIT)
3 to 12 Units @$50 Per Unit
OTHER ADDITIONAL FEES
Manufactured Home Park Lots i
Recreational Vehicle Park Sites
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Fee $20
TOTAL FEE L�.I�G
iimum total fee is $201
that I insoected the electncal installalion descnbed herein on the dates stated:
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Special Inspection $.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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uate: j Rough-in Inspection Required? ❑ Yes 7E] No '�. Inspection Other Than Rough-In: [�Ready Now ❑ Will Call
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' !�" 4�� � �� You must call the inspector when ready! '�, Date Ready:
I certify that I am the LX1 LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
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�, OwnerlOccupant Name ', Please Provide Two (2) Phone Numbers Including Area Code
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' Eledrical Utility i Electrical Utility Address � ��
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�., Contractor / Company Name L - Contractor License Number Master Electrician or Power Limited Technici
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Mailing Address (Contractor, Company or Owner Performing Installation)
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, Authorized Si nature (Con[ractor or Owner Performing Installation) Please Provide Two (2) Phone Numbers Induding Area Code
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