P - 76384REQUEST FOR ELECTRICAL INSPECTION
2��-�'� ra� � 8� � Minnesota Board of Electricity �-;
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
j��q3� (651)642-0800TfY/MRS1-800-627-3529www.electricity.state.mn.us
nbe -using the k f the white copy if necessary - the work covered by this request:
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GENERAL FEES Outdoor Lightin Standard $1
SERVICES / POWER SUPPLIES Traffic Si nal Standard $5
0 to 400 Ampere $25 Su plemental Fee @$20
401 to 800 Am re $50 Transformers u to 10 KVA $10
Above 800 Am re $75 Transformers over 10 KVA $ 20
IRCUITS / FEEDERS Transformer/ Power Su I for S' ns I Outline L' htin $5
0 to 200 Am re$5 ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re $10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two InspecGon Trips Each Dwelling Unit @$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins on Tri s$20
Each Svstem Device or A�oaratus (tD $.50 investiqative Fee
MULTIFAMILY DWELLINGS PEI
3 to 12 Units C� $50 Per Unit
OTHER ADDITIONAL FEES
Li htin ReUofit $25 per Fixture
Center Pivot Irri ation Boom $40
Manufadured Home Park Lots $25
Recreational Vehicle Park Sftes $5
Se rate Bondin Ins 'on $20
S ial Inspection @$30 per Hour
S ecial Ins ion $.31 per Mile
THIS INSTALLATION MAY BE ORDERED
l i�� l I I I I I I l l i� I I I I I I I!! I N I I I I I I I I I I I I I I I� I� I
2 1 2 9 2 8 2 6
TOTALPEE
total fee is $20) � �
I insceded the elecUical instaliatbn desaibed herein on the dates sfated: I
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CTED IF NOT COMPLETED WITHIN 12 MONTHS _______�
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REC'D MaR 3 o f�2007 �- ������v
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Date: Rough-in Inspection Required7 ❑ Yes No Inspection Other Than Rough-In: � Ready Now Will Call
- �b� 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
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� ElecUical Utility Address
�i�ant �F1Qfg Contrador License Number Master Electrician or
9320 Evergreen 8t d NW ��J` 7L% License Number
_ r, ompany or Owner Performing Installaqon)
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