P - 780771-5C.6-255 �
0
GENERALFEES
/ICES I POWER
0 to 400 Amcere
REQl7EST FOR ELECTRICAL INSPECTION
Minnesota Board of EIe�Ctricity ' -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651)642-0SOOTTY/MRS1-800-627-3529 www.electricity.state.mn.us
� Describe -using the back of the white copy if necessary - the work covered by this request:
Outdoor L' htin St�dard E1
Trafic Siqnal Standard � SS
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCU�TS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or ratus E.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Additional Unit � S25
OTHER ADDITIONAL FEES
Li hGn Retrofit $.25 er Fixture
Center Pivot Irri ation Boom $40
M�ufactured Home Parlc Lots $2
Recrea6onal Vehicle Park Sites
arate Bondin Ins tion 520
S ial Ins 'on $30 r Hour
S ial Ins tion $.31 r Mile
THIS INSTALLATION MAY BE ORDERED DI
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Senice andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
TOTAL FEE I �i
(minimum total fee is $20) �/• �
THIS ARFA FOR NbPECTpi USE 0l1Y
I hereby cer6y that I inspecOed the electrical insfalla6on described herein on the dates sta0ed:
( _.-e'' !
�1NOONED
IF NOT COMPLETED WITHIN 12
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1506255? S�pS� �
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Request Date: Rough-in Inspeclion Required? ❑ Yes No Irupedion Other Than Rough-In: dy Now ❑ Wfll Call
I� � �3 You must call the inspecla whan ready! Date Ready:
,
I certiy that I am the � LICENSED CONTRACTOR �1;OMPANY ❑ OWNER and hereby request inspection of the electrical work at: