P - 76385^q REQUEST FOR ELECTRICAL INSPECTION ��`
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2 i O/'� � 6 2 4� Minnesota Board of Electricity ;� I
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 <�-�
C���IQ (651)642-0800TTYIMRSI-800-627-3529www.e/ectricity.state.mn. ��-
Describe -using the back of t ite wpy if necessary - the work covered by this request:
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GENERAL FEES Outdoor Li htin Standard $1
SERVICES / POWER SUPPLIES Traffic Signal Standard @$5
401 to 800 Am ere $50
Above 800 Am ere $75 �
;UITS I FEEDERS �
0 to 200 Am ere a$5 + �
Above 200 Am ere a$10
2M, COMMUNICATION, REMOTE CONTROL, SIGNALING
;UITS, CIRCUITS OF LESS THAN 50 VOLTS
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL
Liahtina Retrofit aC� $.25 cer Fi�ure
Recreational
Special Inspection a$30 per Hour
Special Inspection $.31 er Mile
THIS INSTALI.ATION MAY-1
Supplemental Fee $20
Transfortners u to 10 KVA $10
Transformers over 10 KVA $ 20
Transfortner / Power Su I for Si ns I Outline Li htin $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Fee
TOTALFEE n�.�
total fee is $20) o�
I hereby certify that I inspeded the elecVial insfallafion described herein on the dates sfated:
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;ONNECTED IF •.NOT COMPLETEQ WI7HlN 72 MONTHS
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Date: Rough-in Inspection Required? ❑Yes No Inspection Other Than Rough-In: ❑ Ready Now Will Call
v_ 1'�� 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 eiectrical work at