P - 82020REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity �
1-15 0- 6 5 8 ��� �821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-OS00 TTY/MRS 1-800-627-
www.electricity.state.mn.us � � '' '
Identity the wark covered by this request:
❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR C�
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Treffic Si nal Standard �$5
CIRCUITS / FEEDERS
0 to 200 Am ere �$5
Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or aratus �$.50
ADDITIONS TO THE GENERAL F
Each Addftional Unit � $25
OTHER ADDITIONAL FEES
Liahtina Retrofit � $25 oer Fi�ure
Sup lemental Fee � $20 „
Transformers u to 10 KVA �$10
Transiormers over 10 KVA � $20
Transiortner I Power Su for Si ns i OulVine Li Min �$5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwellin Unit �$8C
Addftional Insoection Trios � $20
I herebv certfv that I
Fee �
(minimum total fee is
• ��9�1
fhe electrical installation described herein �
S ial Ins �on �$30 er Hour "'""` "�'""' ""
Special Inspection � $.31 per Mib `O " ��� �'�
_ THIS INSTALLATION MAY BE ORDERED DISCONNECTED NOT COMPLETED WITHIN 18 MONl'HS
Fon o� use o�x.r
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Request Date: O/ Rough-in Inspedion Required? ❑ Yes ❑ No Inspection Other Than Rough-In: eady Now ��II Cal1
You must call the inspector when readyl Date Ready:
I ceriity that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address (Street, x, or Route No ) Zp �
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Section Township . Range Fire No. Coun ^ .
IOccupant �
Electrical COntractOr �
pEPENDABL
C�on Rapids.
tC. INCa
or Cir�mer Performing Installatlon)
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Phone
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