P - 76612REQUEST FOR ELECTRICAL INSPECTION ��°'���`��
1� v� J� 3 9 9 1 Minnesota Board of Electricity �- �
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104 �-
(651) 642-0800 TTYIMRS 1-800-627-3529 www.electriciry.state.mn.us ���
Describe -using the back of t5ie white copy if necessary - the work covered by this request:
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GENERAL FEES Outdoor Lighting Standard $1
SERVICES I POWER SUPPLIES Tra�c Si nal Standard $5
0 to 400 Ampere @$25 Su plemental Fee $20
401 to 800 Am re $50 Transformers u to 10 KVA $10
AbOve 800 Am re $75 Transformers over 10 KVA $ 20
CIRCUITS / FEEDERS Transformer I Power Su I for Si ns / Outline Li htin $5
0 to 200 Am ere $5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere $10 Inciudes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CANTROL, SIGNALING Circuiis and Two InspecGon Trips Each Dwelling Unit @$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ion Tri s $20
Each S stem Device or Apparatus $.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins ction Fee $20
MULTIFAMILY DWELLINGS PER UNIT TOTAL FEE r� �.�n
3 to 12 Units @$50 Per Unit (minimum total fee is $20) Or(, . o�
Each Add'Aional Unit @ $25
OTHER ADDITIONAL FEES
Lighting Retrofit @ $.25 per Fixture
Center Pivot Irtiaation Boom (� $40
I inspected the electrical installation described herein on the dates slaled: �
Se arate Bondin Ins ction $20 �� � o�
S �al InSpeCtion $30 pef Hour �cP�+eoinanrmorvEO on�
S 'al Inspection $.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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Date: Rou h-in Ins ection R uired? ,,,---,,,���111'''
g p eq ❑ Yes �y�y Inspection Other Than Rough-In: ❑ Ready Now�all
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� ���1p You must call the inspector when ready! ` Date Ready:
I certify that I am the�C
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CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
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Section Range Fire No. County
Gontractor / Company Name
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Mailing Address (Con ctor, ompany or Owner erform
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Authorized Si ature (Contracror or Owner Perfortning I
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Nlease Provitle Two (2) Phone Numbers Including Area
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ador License Number Master Electrician or Power Limited l
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Please Provid� Phone Numbers Including Area
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