P - 76439REQUEST FOR ELECTRICAL ILVSPECTION %�
1 �`� �r,� � 5 3 5 � Minnesota Board of Electricity �(�Q� � (,%� �!� �- :�
1821 University Avenue Suite S-128� Saint Paul, Minnesota 55104 ����.�
�� ^�Sa�j (651)642-0800TTY/MRS1-800-627-3529www.electricity.state.mn.us
Describe -using the back of the wry'� copy if necessary - the work covered by this request:
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GENERAL FEES Outdoor Lighting Standard @$1
SERVICES I 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 Am ere $75 Transformers over 10 KVA $ 20
CIRCUITS / FEEDERS Transformer / Power Su � for Si ns / Outline Li htin $5
0 to 200 Am ere $5 � e�_ ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere $1 Includes the Service and/or Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CANTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit @$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ection Tri s $20
Each S stem Device or A aratus $.50 Investigative Fee
ADDITIONS TO THE GENERAL FEES Reins ction Fee $20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE ly 3_�
3 to 12 UnRs @$5o Per Unit (minimum total fee is $20) `-j,L�i \
Eaeh Additional Unit @$25 niis nREn Foa wsaeeTOa use oNir
OTHER ADDITIONAL FEES
li hting R2trofit $.25 pef Fixtufe I hereby ceRify that I inspected the elecGical inslallation descnbed herein on the dates stated:
Center Pivot Irri ation Boom $40 Rac"�" oA,�
Manufactured Home Park Lots $25
Recreational Vehicle Park Sites C� $5 *� �NS�cnox r, Jy oA,E
ispection @ $.31 per Mile
ALLATION MAY BE
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19425354
iF NOT
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DAIE
IAPLETED WITHIN 72 MONTHS
Date:� Rou h-in Ins edion R uired?
g p eq ❑ Yes �No Inspection Other Than Rough-In: ❑ Ready Now �ill Call
\ Z��� '� You must call the inspector when ready! Date Ready:
I certify that I am the ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Site Street Address City
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Owner/Occupant Name
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Electrical Utility
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ContractorlC���ntral Ave
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Mailing Address (Contra�c��n�r�g�UpAn6e
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�ovide Two (2) Phone Numbers Including Area Code
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License Number Master Electrician or Power LimRed TechnH
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Please Provide Two (2) Phone Numbers Including Area Code
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