P - 77693REQUEST FOR ELECTRIGAL INSPECTION �
� � � ��� � 5 q, � ��� Minnesota Board of Electricity ��,L{-- ��,,���Tj �-�� �:
�, 1821 University Avenue Suite S-128, Saint Paul, Minnesota 6�4`� �`
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
ribe -using the back of the white copy if necessary - the work covered by this request: �
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GENERAL FEES Outdoor Li hting Standard $1
SERVICES I POWER SUPPLIES ,� Traffic Siqnal Standard (a? $5
Above 200 Am ere a$10
ALARM, COMMUNICATION, REMOTE CONTROL, SIG
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or Apparatus $.50
ADDITIONS TO THE GENERAL FEES
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITI01
Lighting Retrofd @ $.25 per Fixture
Center Pivot Irriaation Boom an $40
Transformers over 10 KVA $ 20
Transformer I Power Su I for Si ns / Outline Li htin $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supp�y up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Add'Rional Ins ection Tri s $20
Investi ative Fee
Reins ection Fee $20
TOTAL FEE
(minimum total fee is $20)
7HIS ARE4 FIX2INSPECTOR USE ONLY
I hereby certify that I inspeded the elec6ical insfallation described herein on the dates stated:
Se arate Bondin Ins ion $20 ��-- ��
Speciallns ion $30perHour �01"�"NDONE° . �p�
S iai Ins ection $.31 r Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED_IF NOT COMPLETED WITHIN 12 MONTHS ___
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L8565457
Rough-in Inspedion Required? ❑ Yes ❑ No Inspecfion Other Than Rough-In: � Ready Now�y�Yill �Call
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�" You must call the inspector when ready! Date Ready:
I certify that I am the`�ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical worlc at
Job Site Street Address �^ '^` "��..,
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Name
or
License
Provide Two
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/
or Power Limited
(Contractor or Owner ing Installation) Pl�ase Provi e wo (2) hon umbers I cluding /� ode
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',OF YELLOW COPY BOARD OF ELECTRIGTY COPY E8-00001A-15 8.1. 2004