P - 75905REQUEST FOR ELECTRICAL IIVSPECTION
1_ p��-�/� p� Minnesota Board of Electricity
O �t O 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
Describe -using the back of the whfte copy ff necessary - the work covered by is request:
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i- NERAL F ES Outdoor Lighting Standard @$1
SERVICES / POWER SUPPLIES „p Traffic Siqnal Standard C� $5
u to zUU Am re tD �5 ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re$10 Indudes the Service and/or Power Supply up to 500 Amperes, AO
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuffs and Two Inspection Trips Each DweAing Unit @$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS � Additional Ins 'on Tri $20
Each S m Device or A aratus $.50 Investi ative Fee
ADDRIONS TO THE GENERAL FEES Reins 'on Fee $20
MULTIFAMILY DWELLINGS ER UN TOTAL FEE
3 to 12 Uruts @$50 Per Unit (minimum total fee is $20) ��
EachAdditiOl�alUniteo $25 7°s"�^F��f0R�0�Y
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OTHER ADDITIONAL FEES �
Lightillg ReVoflt @$25 per FlXture I hereby certKy that I Inspeded the electriral histallaBon described hereln on the dates s�ed:
Ce�rter Pivot Irrigation Boom @$40 R01p1 w �^^T�
Manufactured Home Park Lots $25 Y^ �+ ��
Recreadonal Vehicle Park Sftes $5 � °i6PEGT10N �^�
Se rate Bond'm Ins ' n $20 p�"� ���
Special Inspecfion @$30 r Hour 00�0 �� �^�
S ' InspecUon @ $.31 r Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLEiED WITHIN 12 MONTHS
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��' / Rough-in Inspecdon ReqWred9 es �� No Ins on Other Than Rou h-In: y
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� You must caA the inspector when readyl Date Ready: � — � — Q�
I certify that I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Stte Street Add f Eqy
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� �e Plea� Provide Twa (2) Phone Num6ers Induding Area Code
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EI cal Utllity Eledrical UtiGtyAddress
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Contrector J Company Name Contrador Licerise Number Master EI cian or Pawer Lim(ted Technician
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Mailing Address (Contradar, mpeny or Owner Pertorming Installatlon)
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Aufhor� gnature (Contrada efPe�#eaai� Installatlon) Please Provide Two (2) Phorte Numbers Irn�uding Area Code
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