P - 76440REQUEST FOR ELECTRICAL INSPECTION
2� O�F ���� 6 � Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.staJe.mn.us
Describe -using the back of the white copy if necessary - the work covered by this request: „ q,,., j
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-/ GENER4L FEES Outdoor Li htin Standard $1
SERVICES I POWER SUPPLIES Traffic Sianal Standard an $5
Above 200 Am ere a$10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Auoaratus Cd $.50
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
Transformers over 10 KVA $ 20
Transfortner I Power Supply for Signs I Outline Lighting @$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
TOTALFEE
total fee is $201
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OTHER ADDITIONAL FEES
LI htin RetfofR @$.25 pef FiXtu�e I hereby cert'rfy that I inspected the electrical installation desaibed herein on the dates stated:
Center Pivot Irtiga6on Boom $40 RWfiHIN op.�
Manufactured Home Park Lots $25
Recreational Vehicle Park Sites $5 ��"s�ECnor, on.�
Se arateBondin Ins ection $20 /L-�( — U�
Special Inspection $30 r Hour �o�Aeor+oor+eo oA,�
S ecial Inspection $.31 r Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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Date: Rough-in Inspection Required? ❑ Yes ❑ No Inspection Other Than Rough-In: ❑ Ready Now ❑ Will Call
� a�l You must call the inspector when ready! Date Ready:
I ce�tify that I am the 0 LICENSED CONTRACTOR ❑ COMPANY p OWNER and hereby request inspection of the electrical work at
Job Site Street Address City
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OwnedOccupant Name Please Provide Two (2) Phone Numbers Including Area Code
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er Perfo ing In ta tion) Please Provide Two (2) Phone Numbers I
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