P - 77190REQUEST FOR ELECTRICAL INSPECTION � °�,
1 i O'`� 2� 7 1 8 � Minnesota Board of Electricity t: ,:�
1821 University Avenue Suite S-128, Saint I, Minnesota 55104 �:'
(651) 642-0800 TTY/MRS 1-800-62 52 electricity.state.mn.us ,
Desc�be -using the back of the white copy if necessary - the work covered by this request:
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GENERAL F ES Outdoor Li hting Standard $1
SERVICES / POWER SUPPLIES Traffic Si nal Standard @$5
0 to 400 Amcere (� $25 Supplemental Fee $20
Above 200 Am ere $10
ALARM, COMMUN�CATION, REMOTE CONTROI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or An�aratus C�D $.50
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Lighting Retrofit @ $.25 per Fixture
Center Pivot Irriqation Boom C� $40
Special Ins ection a$30 er Hour
Special ins ection a$.31 er Mile
THIS INSTALLATION MAY I
IIII IIIII �IIII IIIII II II) III�I IIIII IIIII �ul I�
L 8 1 2 7 1 8 3
Transformers u to 10 KVA $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 andlor Power Supply up to 500 Amperes, Ail
IG Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additional Ins ction Tri s $20
InvesGgaGve Fee
Reins tion Fee $20
TOTAL FEE ,� ��
(minimum total fee is $20) � ( . .
I hereby certiTythat I inspected Ne electrical installation described herein on the dates stated: �
D IF NOT COMPLETED WITHIN 12 MONTHS
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�ate: Rough-in Inspection Required? ❑ Yes '�yp Inspedion Other Than Rough-In�eady Now ❑ Will Call
_� ✓ ��� � l.�' � You must call the inspector when ready! Date Ready:
I certify that I am the �ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Site Street Address City
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To ns ip Sedion Ranae Fire No. Countv
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IMailing
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(Contractor, Company or ner
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Please Provide Two (2) Phone Numbers
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�I Utility Address
Contrador License Number Master ElecVician or P
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Installadon)
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1 l�.tion) � . Please Pro de Two (2) Phone Numbers
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90ARD OF FI.F(:TRI(:ITV C:nPv
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