P - 80072REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity `�
1- 3� 2� O� V 182� University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651)642-0800 TTY/MRS 1-800-627-3529
` www, electricity.state.mn. us
Identity the work covered by this requesY. ���� ��,�f� �,�—��� _��� 4.,^����� ��-�,��<•�-�/
EW ❑REMODEL ❑ADDITION ❑REPAIR �;i4,G$'-�= �/.�/FJ[r7
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am ere �$25 < Z�i ` Su lemental Fee �$20
401 to 800 Am ere (� $50 Transformers u to 10 KVA �$10
Above 800 Am re �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su I for Si ns / Outline Li htin �$5
0 to 200 Am re �$5 .. 1�� ONE & TWO FAMtLY DWELLINGS, EACH UNI7
Above 200 Am ere �$10 Includes the Service anNor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwellin Unfl �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ection Tri s�$20
Each Svstem Device or Ao�aratus � 5.50 Investiaative Fee
OTHER ADDITIONAL FEES
Lighting ReVOfit � $.25 per Fixture
Center Pivot IrrigaUon Boom � $40
Manufactured Home Park Lots � $25
Recreational Vehide Park Sites � $5
Separate Bonding Inspection � $20
Special Inspection � $30 per Hour
Soecial Insoection � $.31 oer Mile
total fee is
I herebv ceNfv that I insoected the electrical installation de,acr�etl herein on Ihe dates slated:
FOR OFFICE USE ONLY
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Request Date: RougMin InspecUon Required? ❑ Yes No Inspection Other Than Rough-In: ❑ Ready Now Will Call
�'�� "'� � 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 elechical work at
Job Addreas (Street, Box, or Ro No.) City Zip Code
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Section Township Range Fire No. County
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Power Supplier Address
31 CoMractor / �Com �"y Name
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Address (CoMractor, Company r Owner Pertortn
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JiD OF ELECTAICITY COPY
Master License Number
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IN37AUC710/13 ON BACK OF YELLOW COPY�