P - 76641REQUEST FOR ELECTRICAL INSPECTION �'�
� 2�s U��� 15 7� Minnesota Board of Electricity ` -� �
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �,.
(651) 642-0800 TTY/MRS 1-800-6273529 www.electricity.state.mn.us
Describe -using the back of the white copy if necessary - the work cove,r� by this request:
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GEDIERAL FEES Outdoor Lighting ndard $1
SERVICES I POWER SUPFkIES Traffic Si nal Standard $5
0 to 400 Amcere (a� S25 /c� r�, n t SIIf1f1IPfIlPf1TAI FPP n AiO
Above 800 Am ere a$75
CIRCUITS / FEEDERS
0 to 200 Am ere a$5
Above 200 Am re $10
ALARM, COMMUNICATION, REMOTE CANTROL, SIG
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S tem Device or A aratus $.50
ADDITIONS TO THE GENERAL FEES
3 to 12 Units @$50 Per Unit
Each Additional Unft @ $25
OTHER AD
Lighting Retroftt @ $.25 per F
Center Pivot Irtiaation Boom
� Transformers up to 10 KVA @$10
� Transformers over 10 KVA @$ 20
Transformer / Power Supp�y for Sipns / Outline Lightinq $5
ONE 8 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
Additional Ins�ection Trios l� $20
TOTAL FEE --�
total fee je-$20) � �� � � C%
installation desuibed herein on the dates stated:
Se arate Bondin Ins ction $20 2— z7--L 6
S Clal InSpBCtIOn @$30 pef HOUf �cPmEOrneu+ooneo pA�
S 'al Ins ection @$.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS _ _
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I ceRify that I am the �
Job Site SVeet Address
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Electriral Utility
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Rough-in Inspection Required7 ❑ Yes �(No Inspedion Other Than Rough-In: ❑ Ready Now J�ill Call
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You must call the inspector when ready! Date Ready:
;ENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at•
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Section Range Fire No. Coun
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Please Provide Two (2) Phone Numbers InGuding Area Code
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ElecVical Utllitv Address
y name { � Contrador License Number Master Electriaan or Power Limited l
License Number
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itractor, Comp�an/y or Owner Performing InstallaUon) /J^'
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re(ConVactor Owner erformi In Ilation) Please Provide o(2) Phone Numbers Including Area
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CK OF YELLOW COPY AR OF ELECTRIGN COPY FR_l1fN1M G_1 S