P - 77410REQUEST FOR ELECTRICA INSP TI N. �
1�� J�- 4 51 � Minnesota Board of Electricity p� (�� ������-�- �
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �,.'
(651) 642-0800 TTY/MRS 1-800-627-3529 wwiv.electricity.state.mn.us ;;�g,i�
�escribe -using the back of the white copy if necessary - the work covered by this request:
P�CC ,M So�K �'r'T 7- �G! E �
GENERAL FEES Outdoor Li htin Standard @$t
3ERVICES / POWER SUPPLIES n Traffic Si nal Standard $5
0 to 400 Amcere C� $25 rr- i/ SIIf1f1IPf11P0}AI FPP iOi P.iO
I MUL
Above 200 Ampere @$10
2M, COMMUNICATION, REMOTE CONTROL, SIG.
:UITS, CiRCUITS OF LESS THAN SO VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL FEES
3 to 12 Units @$50 Per Unfl
Each Additional Unit @ $25
OTHER ADDITIONAL
Lighting Retroft @ $25 per Fixture
Center Pivot Irriqation Boom (a� $40
Special Inspection @ $30 per Hour
Special Inspection @ $.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCON�
(I�I IIIII III�I Ilfll IIII IIIII IIIII IIIII �� I�
1 8 9 8 4 5 1 8
Transformers u to 10 KVA $10
Transformers over 10 KVA $ 20
Transformer / Power Su I for Si ns / Outline Li htin $5
ONE & TWO FAMILY DWELLINGS, EACIt UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additional Ins ction Trips $20
Investi ative Fee
Reins ection Fee $20
TOTAL FEE
(minimum total fee is $20) �
THIS AREA FOR INSPECTOR USE ON�V
I hereby certify that I inspected the elecMcal installation described herein on the dates stated:
'.���—�
IF NOT COMPLETED WITF
-L 4 -G7
Rough-in Inspection Required? ❑ Yes �Jo Inspection Other Than Rough-In�Ready Now �Will Call
3' � 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: