P - 77142REQUEST FOR ELECTRICAL INSPECTIO �
1 � Q � � � Q � � � Minnesota Board of Electricity��5 - �,�
�� v 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
�— (651)642-0800TTY/MRS1-800-627-3529 www.electricity.state.mn.us
Describe -using the ackpf the white copy'rf ecessary - th rk co r this request:
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GENERAL FEES Outdoor Li htin Standard $1
SERVICES / POWER SUPPLIES Traffic Sianal STandard (aD S5
Above 200 Am ere $10
ALARM, COMMUNICATION, REMOTE CANTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aouaratus (� $.50
Additional Unit @
Lighting Retrofit @ $.25 per Fixture
Center Pivot Irriaation Boom C�D $4f
S ecial Inspection $.31 er Mile
THIS INSTALLATION MAY BE ORDEREC
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L 9 2 4 8 7 4 9
Su lemental Fee a $20
Transformers u to 10 KVA a$10
Transformers over 10 KVA $ 20
Transformer I 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 @ $20
TOTAL
iimum total fee is
I hereby certify that I inspeded fhe elecirical installation described herein on the dates stated: �
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IF NOT COMPLETED WITHIN 12 MONTHS
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I certi(y that I am the�l LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
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ElecUical Utilitv Address
� L��m� Master ElecVician or Power
�� �� License Number
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Please rovid wo (2) Phone Numbers Incluc
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