P - 75781REQUEST FOR ELECTRICAL INSPECTION
I 1� 9 51 "� 16 �� Minnesota Board of Elecficity ,
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 T'fY/MRS 1-800-627-3529 www.electricity.state.mt�.us
Descn'be sing the k the white copy'rf ne�s.sary - cwered by ' ra�uest:
GENERAL FEES Outdoor Lig ting Standard @$1
SERVICES / POWER SUPPLIES Traflic Signal Standard $5
0 to 400 Amoere C�D $25 Su lemerdal Fee @$20
)MMUNICATION, REMOTE CONTROL
CIRCURS OF LESS THAN 50 VOLTS
ivstem Device or Aonaratus C� $.50
OTHER ADDITIONAL FEES
Lighdng Retrofit @ $.25 per Fature
Center Pivot Irriqatlon Boom C�D $40
5 edal Ir�s ectlon a$.31 er Mile
THIS INSTALLATION MAY BE ORDERE
I IUI II I� � III II III (I II� II II� II III II (II �� I�
],9511658
Transformers u to 10 KVA $10
Transformers over 70 KVA $ 20
Transformer / Pouaer Su tor S' ns / Outline Li ' $5
ONE 8 TWO FAMILY DVdELLINGS, EACH UNIT
Includes the Service andlor Power Suppiy up to 500 Amperes, All
Ciresiits aMd Two Inspection Trips Each Dwe�ing Unft (a� $80
Additiorral Ins ection Tri s@$20
Investi ative Fee
Reins �edion Fee a $20
TOTALFEE
(minimum total fee is $20)
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��aaarroo�n �re
ECTED IF NOT COMPLETED WITHIN 12 MONTHS
Fr1R OF�ICE USE ONLY
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�' Rough-in Inspeetlon R uiredl ❑Y� ❑No Ins
eq pedion Otlter Than Rough-In: Ready Now � Wf0 Cap
����� You must ca0 the ins�r when readyl Da�e Ready:
I certify that l am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical wrork at
Job Sfte Street Addr�s 6
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numor¢ea stgna�iitracror or Oxmer Pe ing Installatlon)
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RdSTRUCT10N8 ON CK OF YELLOY� 60ARn nF FI Ff`. ��T�aav r.nw
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�se Number Master Electridan or PrnwE
� Uce�s N�m�ber ��L
Please Provide Two (2) Phorte Numbets Inclt
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