P - 76594REQUEST FOR ELECTRICAL SPECTIO�
1� 9 2 4��9 0 2� Minnesota Board of Electricity � ����� �-.
1821 University Avenue Suite S-128, SainT"Faul, FAinnesota 55104
(651) 642-0800 m/MRS 1-800-627-3529 www.electricity.state.mn.us
Describe -using the back of the white copy'rf necess ry- the work covered by this request:
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GENERAL FEES Outdoor Li hting Standard $1
SERVICES I POWER SUPPLIES Traffic Si nal Standard $5
0 to 400 Ampere $25 Supplemental Fee $20
401 to 800 Am ere $50 Transfortners u to 10 KVA $10
Above 800 Am re $75 Transfortners over 10 KVA $ 20
CIRCUITS / FEEDERS Transfortner I Power Su fw Si ns / Outline Li htin $5
0 to 200 Am ere $5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere $10 Includes the Service and/or Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CANTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit @$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins dion Tri s $20
Each S stem Device or A paratus $.50 Investi ative Fee
ADDITIONS TO THE GENER4L FEES Reins ection Fee $20
MULTIFAMILY DWELLINGS PER UNIT TOTAL fEE ^�
3 to 12 Units @$5o Per Unit (minimum total fee is $20) �l� -� v
Each Additional Unit @$25 THIS AREA FOR INSPECTOR USE ONIY
OTHER ADDITIONAL FEES
Li hti R2VOfit $25 pCr Fixtu�e I hereby certify that I inspected the electrical installafion described herein on the dates stated:
Center Pivot Irti ation Boom $40 Rd1GH IN o,,TE
Manufactured Home Park Lots $25
Recreatbnal Vehicle Park Sites C�D $5 F'"ti'"�Jn'�-� l oA�
S ecial Inspection $.31 er Mile
LTHIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT
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1,9249�28
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12 MONTHS
L°"'' _ l � Rough-in Inspection Required7 ❑Yes �No Inspection Other Than Rough-In: � Ready Now �Will Call �
�� c�-O �S You must call the inspectw when ready! Date Ready:
I certify that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Site Street Address ��y
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Township Section Range Fire No. County
OwnedOccupant Name _ � Piease Pro�ride Two (2) Phone Numbers InGudinq Area Code
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Contrador / Company Na e
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Mailing A� ss (Co�or, Company or Ow
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Authorized Signature (Contrector or Owner I
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INSTRUCTIONS ON BACK OF YELLOW COPY, /
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ConUador License Number Master Electrician or Power
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Perfortmn� I�n Ila6on)
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�mg Installation) lease Provide Two (2) Phone Numbers InGuc
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B ARD OF ELECTRICIN COPY
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FR11fVY11G_15 R 1 �Md