P - 77146REQUEST FOR ELECTRICA INSPECTION � �'�
1� O 1�� 5 0 6 � Minnesota Board of Electricity ��r• Q�4�� �-, :�
� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55 0
-. �'
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
GENERALFEES
Above 800 Am ere $75
GIRCUITS / FEEDERS
0 to 200 Am ere $5
Above 200 Am re $10
ALARM, COMMUNICATION, REMOTE CANTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
3 to 12 Units @$50 Per Unit
Each Add'Aional Unit @ $25
OTHER ADDITI01
Lighting Retrofit @ $.25 per Fixture
Center Pivot Irriaation Boom na $40
ecial Inspection @ $.31 per Mile
INSTALLATION MAY I
I llll II III �� lil II I I II III II III II III II III �� I�
1,81�5062
Sup lemental Fee a $20
Transformers u to 10 KVA a$10
Transformers over 10 KVA $ 20
Transformer I Power Su I for Si ns / Outline Li htin $5
ONE & 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
Fee @ $20
TOTALFEE
iimum total fee is $20)
I herebV certifv that I inspeded the electrical installation desaibed herein on the dates stated: �
C_�-C_ / 2�s.�'
�anr+oor+eo onre
1 IF NOT COMPLETED WITHIN 12 MONTHS
_` ;_ M N � � ""!J � �—
uace: Rou h-in Ins
,� g pection Required? ❑Yes o Inspection Other Than Rough-In: Ready Now �Will Call
��� You must call the inspector when ready! Date Ready:
I cerFrfy that I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection ofthe electrical work at
Job Site SVeet Address City
� � � �� I �L
Township Section Range Fire No. County , n
\ /
Electrical
�onvaaor � company rvame conVactor U�jn ber Master ElecVician or Power LimRed
Harrison Elect. Inc. CA VV� LicenseNumber
Mailing Address (Contr ct r, C m r Owner P orming Ins I on
��4� �`i�mer �ane `�i'. Plymouth 55441
( )