P - 76388REQUEST FOR ELECTRICAL INSPECTION �
� � Minnesota Board of Electricit �
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_ � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 -
C� � (651) 642-0800 TTY/MRS 1-800-6273529 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 hting Standard $1
SERVICES I POWER SUPPLIES Traffic Sianal Standard an. $5
CIRCUITS I FEEDERS
0 to 200 Am re $5 v�^ -
Above 200 Am ere a$10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNA
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or Apparatus $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Add'Rional Unit @ $25
OTHER ADDITIONAL FEES
Li htin Retrofit $.25 per Fixture
Center Pivot Irri ation Boom $40
Manufactured Home Park Lots $25
Recreationai Vehicie Park Sites $5
Se arate Bondin Ins ion $20
Special Inspection $30 per Hour
S ecial Inspection $.31 per Mile
THIS INSTALLATION MAY BE ORDEREI
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19905983
flNE & 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
AddHional Ins ection Tri s a$20
Investi ative Fee
Reins ection Fee a $20
TOTALFEE
(minimum total fee is $20) � � '"—
I inspected the elecVical installation described herein on the dates staled: I
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VECTED IF NOT COMPLETED WITHIN 72 MONTH:
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Date: Rough-in Inspection Required? ❑Yes No Inspedion Other Than Rough-In: � Ready Now Will Call
� ��^�'��� You must call the inspector when ready! Date Ready:
I certi(y that I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Site Street Address t CRy
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13562 C3en1
Mailing Address (
763-75
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rical Udlity Address
ConVactor License Number Master Eledrician or P
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ng Installatlon)
istallation Please Provide Two (2) Phone Numbers
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