P - 76593REQUEST FOR ELECTRICAL INSPECTION �`�'�'�
f., 5'��` �.
1� 8 4�'� 0 7 9 � Minnesota Board of Electricity � '�
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 � R
� �j�� ` (651)642-0800TTYIMRS 1-800-627-3529 www.electricity.state.mn.us �?�
ick of th white copy if necessary - the work covered by this request:
\n.-�-.` � Lv� � ��� ' 0 3 �
GENER4L FEES Outdoor Lighting Standard @$1
SUPPLIES Traffic Siqnal Standard (�a $5
0 to 400
tM, COMMUNICATION, REMOTE CONTROL, SIG
;UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Li htin Retrofit $25 per Fixture
Center Pivot Irri ation Boom $40
Manufactured Home Park LoGs $25
Recreational Vehicle Park Sites $5
Se arate Bondin ins ion $20
Special Inspection $30 per Hour
Special Inspection @ $.31 r Mile
THIS INSTALLATION MAY BE ORDERED
IIII II III II III II III II III II III II III II III �� i�
18420794
Transformers over 10 KVA $ 20
• Transformer / Power Su I for Si ns / Outline Li htin $5
8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additional Ins ection Tri s $20
Investi ative Fee
Reins ion Fee $20
TOTAL FEE
(minimum total fee is $20) 020
THIS AREA FWt INSPECTOR USE ONLV
I hereby certify lhat I inspected the eledrical installation described herein on the dates stated:
<-�S-��I
IF NOT COMPLETED WITF
a a�� - oo `���
Rough-in Inspection Required? ❑ Yes �o Inspection Other Than Rough-In: ❑ Ready Now l�will Call ��
�� (� v� You must call the inspedor when ready! Date Ready: �`
I certify that I am the� ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at: