P - 77155REQUEST FOR ELECTRICAL INSPECTION �'�
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� � ❑ Minnesota Board of Electricity k �,
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
C� � �,r��j (651)642-0800TTY/MRS1-800-627-3529 www.electricity.state.mn.us �"�,��
Describe -using the back of the white y if necessary - the work covered by this request:
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GENERAL FEES Outdoor Li htin Standard $1
SERVICES I POWER SUPPIIES Traffic Siqnal Standard (�a $5
Above 200 Am ere a$10
ALARM, COMMUNICATION, REMOTE CANTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aooaratus an $.50
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Lighting Retrofit @ $.25 per Fixture
Center Pivot Irriaation Boom na $40
Transfortner I Power Su I for Si ns / Outline Li htin $5
0 E& TWO FAMILY DWELLINGS, EACH UNIT
s the Service and/or Power Supply up to 500 Amperes, All
NG ircuits and Two Inspection Trips Each Dwelling Unit @$80
Additional Insoection Trios (�a $20
Special Ins ection a$30 per Hour
S ecial Ins ction $.31 er Mile
THIS INSTALLATION MAY BE ORDERED DIS
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total fee is $20) I p2
I inspected the electrical installalion described herein on ihe dafes stated:
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NNECTED_IF NOT COMPLETED WITHIN 12 MONTHS _____�
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Date: Rough-in Inspection Required? ❑Yes No Inspection Other Than Rough-In: � Ready Now Will Call
�—�' 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 electrical work at
Job Site Street Address City
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Township Section Range Fire No. County .
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Owner/Occupant Name Please Provide Two (2) Phone Numbers Including Area Code
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Electrical Ufility Electrical Utllity Address
I Contractor / Company
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or
:nse Number Master Electrician or Power Limited TechniCian
� � � License Number
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