P - 77040REQUEST FOR ELECTRIC�L Ily.$PECTION �
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I l� � O J- 8 9 2� Minnesota Board of Electricity q Q�S ����� �` ?�
1821 University Avenue Suite S-128, Saint Paul, Minnesota 1 �3: '�,.
(651) 642-0800 TTY/MRS 1-800-627-3529 w�tnv.electricity.state.mn.us �s�=�
Describe -using the back of the white wpy if necessary - the work wvered by this request:
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GE RAL FEES Outdoor Lighting Standard @$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard @$5
0 to 400 Ampere $25 Supplemental Fee $20
401 to 800 Am re $50 Transformers u to 10 KVA $10
Above 800 Ampere $75 Transformers over 10 KVA $ 20
CIRCUITS / FEEDERS Transformer / Power Su I for 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 CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit @$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Inspection Tri�s (a� $20
Each System Device or Apparatus $.50
ADDITIONS TO THE GENERAI f
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Lighting Retrofit @ $.25 per Fi#ure
Center Pivot Irrigation Boom @ $40
Manufactured Home Park Lots $25
Recreational Vehide Park Sites (� 85
TOTAL FEE I
(minimum total fee is $20) ��„� .�Z.7
TNIS HREA FOR INSPECTpft USE INJLV
I hereby cerlify ihat I inspeded the electnral inslallation descnbed herein on the dates stated:
Special Inspection @ $.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS _
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L8858928
"°,`. Rough-in Inspection Required? ❑ Yes $�'No Inspection Other Than Rough-In: ❑ Ready Now�Will Call
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t`) I �� I�-, 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:
Job Site Street Address City
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Township Section Range Fire No. County
Owner/Occupant Name Please Provide Two (2) Phone Numbers Including Area Code
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�F YELLOW COPY BOARD OF ELECTRICITY COPV
Master Electncian or Power Limited Technician I
License Number